49-Year-Old Female with Androgenetic Alopecia and Melasma
Introduction
Hair thinning and pigmentary skin changes are two of the most common concerns among women in midlife. At Reena Jogi MD Dermatology in Houston and Katy, Texas, we often evaluate women who experience androgenetic alopecia—a gradual, genetically influenced form of hair loss—and concurrent skin conditions such as melasma, a chronic hyperpigmentation triggered by hormones and sun exposure.
This case highlights a 49-year-old woman undergoing treatment for female pattern hair loss with oral medications while managing facial melasma through advanced topical therapy.
Patient Case
A 49-year-old female presented with a three-year history of diffuse hair thinning on the scalp. The hair loss was moderate in severity and gradually progressive. The patient had previously tried topical minoxidil in 2023 but discontinued due to leg swelling and puffiness. She later restarted oral minoxidil 2.5 mg daily in June 2025.
In addition to hair loss, the patient reported hyperpigmented facial patches consistent with melasma, for which she was using a compounded hydroquinone (HQ 6%)/hydrocortisone/retinoic acid cream with good results.
Examination
Scalp: Diffuse thinning over the crown and vertex consistent with androgenetic alopecia (L64.8).
Skin: Ill-defined hyperpigmented patches in the malar and periorbital areas, consistent with melasma (L81.1).
General: Patient appeared healthy, alert, and well-nourished.
Diagnosis
Androgenetic Alopecia (Female Pattern Hair Loss)
Melasma
Treatment Plan
1. Androgenetic Alopecia
After a detailed discussion of treatment options—including oral minoxidil, spironolactone, finasteride/dutasteride, PRP, Alma TED, laser therapy, and nutritional supplements—the patient elected to continue oral minoxidil 2.5 mg daily and begin spironolactone 50 mg twice daily.
Counseling provided:
Oral Minoxidil: Possible side effects include ankle swelling, dizziness, unwanted facial hair growth, and temporary shedding in the first 8–10 weeks.
Spironolactone: Discussed risks such as fatigue, dizziness, menstrual irregularities, and elevated potassium levels. The medication should not be used during pregnancy.
The patient was informed that spironolactone may also alleviate swelling related to prior minoxidil use due to its mild diuretic effect.
If minimal improvement is seen over the next 6 months, transition to finasteride or dutasteride will be considered following IUD placement.
2. Melasma
The patient reported satisfactory results from her compounded 6% hydroquinone formula and expressed interest in further improvement. After counseling, we recommended transitioning to a stronger compounded cream containing:
Hydroquinone 12%
Kojic acid 6%
Usage instructions:
Apply a pea-sized amount to affected areas twice daily for 2–3 months, followed by reassessment.
Always use broad-spectrum sunscreen daily to prevent pigment recurrence.
Counseling included:
Limit hydroquinone use to 2–3 month intervals to avoid pseudoochronosis (skin darkening).
Safe to use concurrently with retinoids, vitamin C, glycolic acid, and tranexamic acid.
Avoid products containing resorcinol, mercury, phenol, or benzene.
Discussion
This case demonstrates the importance of combining medical and cosmetic dermatology to address common overlapping conditions in women—hair loss and melasma.
Androgenetic alopecia is a slowly progressive, hormonally influenced condition that can significantly affect self-esteem. Early intervention with oral minoxidil and spironolactone offers a safe, effective, and well-tolerated regimen for women.
Melasma, while benign, requires careful management with compounded hydroquinone formulations, topical antioxidants, and daily sun protection to prevent recurrence.
At Reena Jogi MD Dermatology, individualized care ensures patients achieve optimal results for both scalp and skin health.
Follow-Up
The patient will follow up in 6 months to assess hair growth progress and skin pigmentation response.
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