24-Year-Old Female with Hair Loss and Folliculitis Associated with GLP-1 Therapy
Introduction
Hair loss can arise from multiple contributing factors — hormonal changes, stress, nutritional imbalance, or medications. At Reena Jogi MD Dermatology in Houston and Katy, Texas, we often see patients experiencing telogen effluvium (TE) triggered by new medications or systemic changes. This case features a 24-year-old female with recent hair shedding after starting a GLP-1 receptor agonist (tirzepatide) and concurrent folliculitis of the groin.
Patient Case
A 24-year-old female presented with diffuse scalp hair loss and itchy follicular bumps in the groin.
The patient reported starting tirzepatide (a GLP-1 agonist used for weight management) approximately four months ago, followed by noticeable hair shedding one month later. She denied other triggers such as recent illness, thyroid disease, or iron deficiency.
Additionally, she reported recurrent folliculitis—tender, pustular bumps in the mons pubis region—occurring after shaving.
Examination
Hair Findings: Diffuse thinning on the scalp, particularly in the left superior parietal region. Hair pull test positive for telogen hairs.
Scalp: No erythema, scarring, or scaling noted.
Groin: Multiple follicular-based pustules on the mons pubis consistent with folliculitis.
Other Findings: A benign dome-shaped nodule on the left thigh consistent with dermatofibroma.
Diagnosis
Telogen Effluvium (L65.0)
Folliculitis (L73.9)
Dermatofibroma (D23.72)
Discussion
Telogen effluvium (TE) occurs when a larger-than-normal number of hair follicles enter the resting phase, leading to diffuse shedding. TE can be triggered by new medications, stress, thyroid abnormalities, or rapid weight loss — all of which are potential consequences of GLP-1 receptor agonist therapy.
In this case, the onset of hair loss aligned closely with the initiation of tirzepatide, suggesting a medication-associated TE.
Additionally, the patient displayed features of underlying androgenetic alopecia (AGA), a genetic form of progressive hair thinning often coexisting with TE.
The patient’s folliculitis was likely secondary to mechanical irritation and ingrown hairs from shaving.
Treatment Plan
1. Telogen Effluvium & Androgenetic Alopecia
Medication: Started oral minoxidil 2.5 mg, half tablet daily.
Counseled on possible side effects such as ankle swelling, dizziness, or unwanted hair growth.
Advised that initial shedding during the first 8–10 weeks is normal.
Discussed additional treatment options including:
Finasteride or spironolactone
Low-level laser therapy (Theradome)
Supplements such as Nutrafol or Viviscal
The patient elected to continue with oral minoxidil and reevaluate in 6 months.
2. Folliculitis
Topical Clindamycin 1% lotion applied daily to affected areas.
Benzoyl Peroxide wash recommended for antibacterial control.
Advised to avoid shaving closely and to use warm compresses for inflamed lesions.
3. Dermatofibroma
Educated that the lesion is benign and removal is only necessary if painful or enlarging.
Counseling and Expectations
The patient was counseled that telogen effluvium is temporary, often improving within 6–9 months after the trigger resolves. However, due to the presence of underlying androgenetic alopecia, long-term maintenance with minoxidil or other medical therapies may be needed.
The folliculitis is expected to improve within a few weeks with proper skin care and topical antibiotics.
Follow-Up
The patient will follow up in 3 months for reassessment of folliculitis and in 6 months for hair density evaluation.
Key Takeaway
This case highlights a GLP-1-associated telogen effluvium with underlying androgenetic alopecia, emphasizing the importance of identifying medication triggers and overlapping hair loss conditions. At Reena Jogi MD Dermatology, we offer comprehensive, individualized treatment plans for both hair and scalp health across the Houston and Katy communities. Call the office at 7134874061 to schedule your consultation now!
