49-Year-Old Female with Telogen Effluvium and Seborrheic Dermatitis
Introduction
Hair loss in women can often be multifactorial, triggered by stress, hormonal fluctuations, nutritional deficiencies, or scalp conditions. At our dermatology offices in Houston and Katy, Texas, we frequently treat patients experiencing Telogen Effluvium (TE) — a temporary form of hair shedding — sometimes accompanied by seborrheic dermatitis, a chronic scalp condition that can worsen shedding. This case describes a 49-year-old woman presenting with stress-related hair loss and scalp inflammation.
Patient Case
A 49-year-old female presented as a new patient with a six-month history of diffuse hair loss. The patient reported significant stress during the past year but denied recent illness or medication changes. She had tried no formal treatments before this visit.
Examination
Findings: Diffuse hair thinning and shedding on the scalp, with a positive hair pull test confirming active Telogen Effluvium.
Location: Left superior parietal scalp.
Scalp condition: No scarring or erythema noted.
Additional finding: Mild seborrheic dermatitis with pink-orange scaly plaques.
The patient appeared well-nourished, alert, and in no acute distress.
Diagnosis
Telogen Effluvium (L65.0)
Seborrheic Dermatitis (L21.8)
Discussion
Telogen Effluvium (TE) is a temporary form of hair loss triggered by physiological or emotional stressors that push hair follicles prematurely into the shedding phase. In this patient’s case, chronic stress likely contributed to the onset of TE. The positive hair pull test confirmed active shedding, and the absence of scarring or redness ruled out more serious forms of alopecia.
Because TE often overlaps with other scalp conditions, identifying and treating contributing factors such as seborrheic dermatitis is essential for optimal regrowth.
Treatment Plan
After discussing multiple treatment options—including oral and topical minoxidil, finasteride, spironolactone, supplements (Nutrafol, Viviscal), PRP, and Alma TED therapy—the patient opted for a more conservative initial approach.
1. For Telogen Effluvium
Supplement therapy: Started on Xtresse gummies, an over-the-counter supplement that supports hair growth and stress balance.
Topical treatment: Recommended Minoxidil 5% topical solution, to be applied daily to stimulate follicular growth.
Education: Explained that shedding may initially increase during the first 8–10 weeks before improvement occurs.
Future options: Discussed PRP and Alma TED as potential adjunct treatments if shedding persists.
2. For Seborrheic Dermatitis
Ketoconazole 2% shampoo: Apply at least three times weekly to reduce inflammation and yeast buildup.
Fluocinonide 0.05% topical solution: Apply twice daily during flares, limited to two weeks per month.
Maintenance: Alternate medicated shampoo with an over-the-counter zinc pyrithione or selenium sulfide shampoo for daily use.
Counseling and Expectations
The patient was counseled that Telogen Effluvium is self-limiting and often resolves within several months once the triggering factor—such as stress—is addressed. Stress reduction and scalp care were emphasized as essential components of management.
Follow-up: Scheduled in 3 months to monitor regrowth and reevaluate the response to treatment.
Key Takeaway
This case demonstrates the importance of a comprehensive approach when evaluating hair loss in women. Addressing both internal triggers (like stress) and external scalp conditions (like seborrheic dermatitis) improves the chance of full recovery. At Reena Jogi MD Dermatology in Houston and Katy, Texas, we create personalized plans combining medical therapy, supplements, and scalp treatments to restore healthy, fuller hair. Call the office now at 7134874061 to schedule your consultation!
