26-Year-Old Female Follow-Up for Androgenetic Alopecia & Seborrheic Dermatitis | Reena Jogi MD Dermatology in Houston & Katy, Texas
Managing chronic hair loss often requires consistency—and even a brief interruption in treatment can lead to worsening shedding. A 26-year-old woman returned to Dr. Reena Jogi’s dermatology practice in Houston and Katy, Texas for follow-up care after running out of her prescribed spironolactone for several months.
She reported renewed hair thinning, dandruff, and scalp dryness but no significant medication side effects. This visit focused on restarting long-term treatment for androgenetic alopecia (AGA) and addressing a flare of seborrheic dermatitis.
Case Summary
Chief Complaint
Diffuse hair thinning
Scalp dryness and dandruff
History of Present Illness
The patient had been on spironolactone for AGA but stopped it for 2–3 months due to lack of follow-up. She restarted it two weeks prior to her visit. She denied side effects and requested additional refills.
She also reported flaking and dryness consistent with seborrheic dermatitis, a chronic inflammatory scalp condition.
Examination
Diffuse thinning consistent with female pattern hair loss
Pink/orange scaly plaques on the scalp
No signs of scarring alopecia
Dermatoscopic findings supportive of AGA and seborrheic dermatitis
Diagnosis
1. Androgenetic Alopecia (Female Pattern Hair Loss)
(L64.8)
AGA is a genetically determined, slowly progressive type of diffuse thinning. For women, this typically presents as a widened midline part and overall decreased density without frontal recession.
This patient responded positively to spironolactone previously, making continued therapy appropriate.
2. Seborrheic Dermatitis
(L21.8)
Characterized by erythematous, flaky plaques, this chronic scalp condition often worsens during stress and improves with medicated shampoos and topical steroids.
Treatment Plan
⭐ 1. Spironolactone 100 mg Daily
Prescription:
Take 1 tablet (100 mg) daily
90 tablets, 3 refills
Follow up in 1 year
Counseling reviewed:
Drink plenty of water
Possible side effects include dizziness, menstrual irregularities, fatigue, and breast tenderness
Avoid during pregnancy
Seek care if hair loss worsens or side effects develop
Because she improved previously on spironolactone, long-term use with annual follow-up was recommended.
⭐ 2. Seborrheic Dermatitis Treatment
Ketoconazole 2% Shampoo
Use at least 3 times weekly
Leave on the scalp before rinsing
Helps reduce scalp inflammation and yeast overgrowth
Fluocinonide 0.05% Solution
Apply twice daily during flares
Limit use to no more than 2 weeks per month
Over-the-Counter Options
Alternate ketoconazole with OTC shampoos containing:
Selenium sulfide
Zinc pyrithione
Coal tar
A handout with product options was provided.
Counseling & Expectations
For Androgenetic Alopecia
AGA is genetically pre-determined and slowly progressive
Treatment aims to stop progression and improve density
Options reviewed included:
Topical minoxidil
Supplements (Nutrafol, Viviscal, Votesse)
Low-level laser therapy
PRP therapy
Results typically take 4–6 months to notice
For Seborrheic Dermatitis
Chronic condition with periodic flares
Stress, weather changes, and buildup of scalp oils can trigger symptoms
Medicated shampoos and topical steroids help manage flares
Follow-Up
4–6 weeks for seborrheic dermatitis
1 year for AGA monitoring unless symptoms change
Dermatology Expertise for Hair Loss & Scalp Conditions in Houston & Katy, Texas
Managing hair loss requires personalized care, ongoing evaluation, and long-term planning. At Reena Jogi MD Dermatology, our team specializes in both hair disorders and scalp health, including androgenetic alopecia, telogen effluvium, seborrheic dermatitis, and more.
If you're experiencing hair thinning or scalp symptoms, schedule a consultation at our Houston or Katy clinics for expert evaluation.
