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October 1980

Toxic Alopecia Caused by Pyridostigmine Bromide

Author Affiliations

San Luis Obispo, Calif

Arch Dermatol. 1980;116(10):1103. doi:10.1001/archderm.1980.01640340013009

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To the Editor.—  Pyridostigmine bromide (Mestinon) is an orally active cholinesterase inhibitor used to treat myasthenia gravis. Its major side effects are generally related to over-dose and are characterized by muscarinic or nicotinic effects. An occasional bromide reaction has also been seen. However, no reported case of hair loss from this drug is known to me or the manufacturers. I report here a case of possible toxic hair loss from this drug.

Report of a Case.—  Myasthenia gravis developed in a 69-year-old woman in August 1977. Her neurologist instituted pyridostigmine bromide therapy on Sept 9, 1977, gradually increasing the dosage to 360 mg/day. Later, 40 mg/day of prednisone was given starting on Nov 15, 1977. All treatment was discontinued for the next two weeks because of muscle cramps, fasciculations, diarrhea, and headaches. On Dec 18, 1977, the patient noted a sudden, severe, and extensive generalized hair loss. Thyroid extract therapy

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