37-Year-Old Female with Chronic Hair Shedding and Scalp Irritation — Telogen Effluvium and Seborrheic Dermatitis
Background
A 37-year-old woman presented to Reena Jogi MD Dermatology in Katy, Texas, for evaluation of progressive hair thinning and scalp irritation. She reported diffuse hair loss over several years, gradually worsening since the postpartum period. The patient described the shedding as moderate in severity and persistent, with no associated pain, itching, or redness.
She denied any recent illnesses, surgeries, or new medications. There was a family history of hair loss in her mother. At the time of presentation, she was not using any hair loss treatments and was not actively preventing pregnancy.
Examination
A comprehensive skin and scalp examination was performed, including evaluation of the scalp, face, neck, and hair follicles.
Findings included:
Diffuse hair thinning over the crown and frontal scalp
Positive hair pull test for telogen hairs
Mild flaking and redness consistent with seborrheic dermatitis
The patient was otherwise well-appearing, alert, and in no acute distress.
Diagnosis
The clinical findings were consistent with two concurrent scalp conditions:
Telogen Effluvium (L65.0) — chronic hair shedding likely triggered postpartum, now persisting as a secondary form of hair loss.
Seborrheic Dermatitis (L21.8) — a chronic inflammatory scalp condition causing mild scaling and irritation.
Treatment Discussion
Dr. Jogi discussed that telogen effluvium often follows physical or emotional stressors, hormonal changes, or nutritional deficiencies. Although it typically improves over time, underlying androgenetic or chronic shedding patterns can persist and require active management.
The patient was counseled on the multifactorial nature of hair loss, including the importance of addressing scalp inflammation from seborrheic dermatitis to optimize hair regrowth.
For Seborrheic Dermatitis
To control flaking and inflammation:
Ketoconazole 2% shampoo: Apply to the scalp and leave on for 5–10 minutes before rinsing, 1–3 times per week for maintenance.
Fluocinonide 0.05% topical solution: Apply twice daily to affected areas as needed during flares only.
Counseling:
Chronic condition with intermittent flares and remissions.
Stress may trigger flare-ups.
Prolonged use of potent topical steroids can cause skin thinning and visible blood vessels (telangiectasias); to be used sparingly and not on the face or groin.
For Hair Shedding (Telogen Effluvium)
After discussing treatment options, the patient elected to start a compounded topical minoxidil solution (7% minoxidil / 0.0125% retinoic acid).
Instructions for Use:
Apply once or twice daily to all areas of thinning scalp.
Allow to dry fully before lying down or using other hair products.
Wash hands after application.
Shedding in the first 4–8 weeks is expected and normal.
Noticeable improvement typically occurs after 3–6 months of consistent use.
Alternative and Adjunct Options Discussed:
Oral minoxidil (low-dose formulation)
Spironolactone for hormonal-related thinning
Nutritional supplements such as Nutrafol®, Viviscal®, or Xtress®
Low-Level Laser Therapy (LLLT) caps or helmets
AlmaTED® noninvasive hair restoration
The patient was informed that procedural therapies like PRP and AlmaTED are considered cosmetic and not typically covered by insurance.
Follow-Up Plan
Recheck in 6 months to assess hair density and response to treatment.
Laboratory testing recommended to evaluate for thyroid function, iron deficiency, and hormonal imbalance, as underlying contributors to chronic hair shedding.
Discussion
This case highlights the importance of identifying and managing overlapping causes of female hair loss. Postpartum and chronic telogen effluvium often coexist with seborrheic dermatitis, creating both inflammatory and shedding components that must be addressed together.
At Reena Jogi MD Dermatology in Katy and Houston, Texas, we specialize in comprehensive hair loss evaluation and scalp health optimization, combining medical therapy, topical formulations, and advanced treatments like PRP and AlmaTED to achieve natural, sustainable results. Call the office now at 7134874061 to schedule your consultation!
