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Fluoxetine- and Sertraline-Related Hair Loss in a Teenager: a Case Report

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Fluoxetine- and Sertraline-Related Hair Loss in a Teenager: a Case Report Olgu Sunumları / Case Reports DOI: 10.5455/bcp.20120928030857 Fluoxetine- and Sertraline-Related Hair Loss in a Teenager: A Case Report Serhat Turkoglu1 ÖZET: ABS TRACT: Bir ergende fluoksetin ve sertralin ile ilişkili Fluoxetine- and sertraline-related hair loss in a saç dökülmesi: Olgu sunumu teenager: a case report Selektif serotonin reuptake inhibitörleri (SSRI) yaygın Selective serotonin reuptake inhibitors (SSRIs) are widely olarak kullanılan antidepresanlardır. Tüm SSRI’lar ile prescribed antidepressants. All SSRIs have occasionally ilişkili zaman zaman yaygın saç dökülmesi bildirilmiştir. been associated with alopecia or hair loss. There might be SSRI’ların saç dökülmesi riskiyle ilişkili farklı oranlar differences in the risk of alopecia between the various SSRIs, 1M.D., Specialist in Child and Adolescent bildirilmiş ve riskin kadınlarda daha fazla olduğu belir- and the risk might be higher in women than in men. The Psychiatry, Child and Adolescent tilmiştir. Psikotropların saç kaybına yol açma meka- pathological mechanism of hair loss due to psychotropic Psychiatry Service, Ordu State Hospital, Ordu - Turkey nizması henüz tamamen aydınlatılamamıştır. Bu olgu medications has not yet been fully elucidated. Here, we sunumunda, ilk olarak fluoksetin ve sonrasında sertralin present an adolescent female with no personal and family Ya zış ma Ad re si / Add ress rep rint re qu ests to: Serhat Turkoglu, M.D., Specialist in Child başlanmasının ardından özgeçmişinde ve aile öyküsün- history of alopecia, who developed common alopecia with and Adolescent Psychiatry, Child and de olmadığı halde, yaygın saç dökülmesi gözlenen bir consecutive fluoxetine and sertraline treatments. The hair Adolescent Psychiatry Service, Ordu State Hospital, Ordu - Turkey ergeni bildiriyoruz. Bizim bilgilerimize göre bu olgu, loss stopped with a venlafaxine regimen. To our knowledge, hem fluoksetin hem de sertralin ile yaygın saç dökülme- this is the first report of hair loss due to both fluoxetine and Elekt ro nik pos ta ad re si / E-ma il add ress: [email protected] si görülen, ardından tedavisine venlafaksin ile devam sertraline, which then recovered with venlafaxine treatment. Gönderme tarihi / Date of submission: edilen ve saç dökülmesi duran ilk olgudur. SSRI tedavisi If a patient develops hair loss during SSRI treatment and the 30 Ocak 2011 / January 30, 2011 sırasında hastada saç kaybı gelişir ve zamansal ilişki temporal relationship seems plausible, an adverse drug Kabul tarihi / Date of acceptance: olarak akla yatkın görünürse, ilaç yan etkisinden şüphe reaction should be suspected and changing the treatment 28 Eylül 2012 / September 28, 2012 edilmeli, ya doz düşürülerek ya da başka bir antidepre- to another antidepressant or possibly decreasing the dose sana geçilerek tedaviye müdahale edilmelidir. should be considered. Bağıntı beyanı: S.T.: Yazar bu makale ile ilgili olarak herhangi bir çıkar çatışması Anahtar sözcükler: Fluoksetin, sertralin, alopesi, yan Key words: Fluoxetine, sertraline, alopecia, side effects bildirmemiştir. etkiler Declaration of interest: Bulletin of Clinical Psychopharmacology 2013;23(1):77-80 S.T.: The author reported no conflict of Kli nik Psikofarmakoloji Bülteni 2013;23(1):77-80 interest related to this article. INTRODUCTION including eating disorders, panic disorder, obsessive-compulsive disorder and borderline Selective serotonin reuptake inhibitors (SSRIs) personality disorder (1). are widely prescribed antidepressants. The Most people have about 100,000 scalp hairs. introduction of fluoxetine in 1988, followed by other Shedding of 100 to 150 hairs per day is normal. The SSRIs, which have a much more favorable profile of term alopecia is considered to encompass all forms adverse effects, has significantly broadened the of hair loss ranging from simple defluvium to total horizon for pharmacological treatment of disorders loss of body hair. Thinning of the hair is difficult to of mood and anxiety. Although depressive disorders detect clinically until about 25–50% of the hairs on were the initial indications for these medications, the scalp are lost. Hair loss is, therefore, often a they are effective in a wide range of disorders, subjective complaint by the patient, who notices an Klinik Psikofarmakoloji Bülteni, Cilt: 23, Sayı: 1, 2013 / Bulletin of Clinical Psychopharmacology, Vol: 23, N.: 1, 2013 - www.psikofarmakoloji.org 77 Fluoxetine- and sertraline-related hair loss in a teenager: a case report increased loss of hair when brushing or washing the CASE hair (2). Hair loss may be frequently caused by medicines A.K. a 16-year-old female was referred to our as a side effect. Hair loss is a rare side effect of outpatient clinic with complains of irritability, psychotropic agents (2). Alopecia occurs in about depressed mood, markedly diminished interest, 10% of persons managed on lithium, up to 12% of fatigue, psychomotor agitation, recurrent thoughts persons on valproate and less than 6% of individuals of death, diminished concentration, sleep on carbamazepine (3). Tricyclic antidepressants, disturbance, lack of appetite, significant weight maprotiline, trazodone, and virtually all the new loss, restlessness, muscle tension, excessive worries generation of antidepressants may rarely lead to about school, future, health of family and reportedly alopecia. The same applies to haloperidol, drinking alcohol to “get drunk” in the several olanzepine, risperidone, clonazepam, and months prior to the evaluation. She had been buspirone, but not to other neuroleptics, diagnosed with DSM-IV generalized anxiety benzodiazepines or barbiturates, selected disorder and major depression. She did not fulfill antihistamines, and antiparkinson drugs (4). All the DSM-IV criteria for any other Axis I or personality SSRIs have occasionally been associated with disorder. She had a normal physical examination alopecia or hair loss. It is believed that most drug- and no history of significant medical illness. She induced alopecia is due to the conversion of growing had not been treated previously with any other hair follicles into resting hair follicles (4). Physicians serotonergic antidepressant. Her fluoxetine often don’t enquire about this side effect and regimen started with 10 mg daily and gradually therefore may not recognize it. Although patients increased to 40 mg/day. Ten weeks later, symptoms recognize this side effect, they usually don’t connect of generalized anxiety disorder and major hair loss with the drug they use. For these reasons, depression were dramatically reduced on this the real prevalence of hair loss due to psychotropic regimen. Approximately five weeks after starting drugs is not obvious (5). Dermatological side effects fluoxetine she and her mother noticed that more may occur such as redness, rash or sweating with all scalp hair appeared in her comb and on herpillow. the SSRIs. Hair loss may progress to alopecia. Hair Scalp pain didn’t accompany with this noncicatrical loss is a potential but an infrequent side effect (4). hair loss. She was found to have noncicatricial Fluoxetine (6,7), sertraline (8) and paroxetine (9) alopecia in patches around the frontal and temporal have been reported to cause hair loss in a very small areas of the scalp. She was not taking any other minority of patients. medication and had no history of allergies. In her The mechanism of SSRI-induced hair loss has personal and familial history there was no history of not been elucidated. There are 2 stages of alopecia, hair loss at early ages. She consulted the Dermatology anagen and telogen effluvium, both of which may Clinic and she was diagnosed with hair loss of be associated with medication-related alopecia. unknown cause. The results of hematological Telogen effluvium may be a consequence of a large investigation and renal, liver and thyroid function number of medications including psychotropic tests revealed no abnormality. Thyroid antibodies drugs.(10). Side effects of medications on hair are and antinuclear antibodies were not found. not limited to loss only since they might also change Serological tests confirmed that A.K. did not have the color of the hair (11). syphilis. Rheumatoid factors were not present. Here we present an adolescent, who developed Because a drug-related event was suspected, diffuse alopecia during both fluoxetine and fluoxetine was discontinued 3 months later. A. K’s sertraline treatment with no personal and family hair loss ceased and her hair returned to normal history of alopecia. Afterwards, sertraline and thickness. Four weeks after stopping fluoxetine fluoxetine were discontinued and hair loss resolved treatment, due to an increase of symptoms, A.K. within three weeks. was prescribed sertraline 50 mg/day by her 78 Klinik Psikofarmakoloji Bülteni, Cilt: 23, Sayı: 1, 2013 / Bulletin of Clinical Psychopharmacology, Vol: 23, N.: 1, 2013 - www.psikofarmakoloji.org Turkoglu S psychiatrist. Within 1 week, the patient’s hair loss mechanism of drug-induced hair loss is called recurred and she stopped taking sertraline. A.K. telogen effluvium and involves a premature reported renewed hair growth. Four weeks later interruption of growth with an early entry of anagen when symptoms increased again, a venlafaxine follicles into the resting phase. Hair loss tends to regimen was started with a dose of 37.5 mg which occur within three months of initiating therapy but was gradually increased to 150 mg/day. Ten weeks may be further delayed (2,4). Drug-induced hair later, the symptoms of generalized anxiety
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