Alopecia Areata and Androgenetic Alopecia: Dual Diagnosis in a 54-Year-Old Female Patient

At our dermatology practice in Katy and Houston, Texas, we frequently evaluate patients presenting with hair loss. In this case, a 54-year-old woman came to us with a one-week history of sudden focal hair loss on her scalp. She was otherwise well-nourished and in no acute distress.

Case Summary

The patient presented with a distinct sparse patch of hair loss on the mid-occipital scalp—a classic sign of alopecia areata, an autoimmune condition characterized by non-scarring, patchy hair loss. The onset was rapid, and the patient had no prior treatment for this specific issue. Upon examination using dermatoscopy, the lesion confirmed clinical suspicion.

Simultaneously, the patient showed diffuse thinning consistent with androgenetic alopecia (AGA)—a genetic condition causing progressive, patterned hair loss in women.

Treatment Plan

1. Alopecia Areata

To address the localized patch of hair loss:

• Intralesional Kenalog injections (ILK) were administered during the visit.

• A total of 6 lesions were injected using 2.5 mg/cc Kenalog, diluted from a 10 mg/ml solution.

• Risks, including atrophy, were explained, and the patient tolerated the procedure well.

2. Androgenetic Alopecia

Although the patient was not currently distressed by overall thinning, we provided educational counseling and a long-term plan:

• Nutrafol Women’s Balance supplement was recommended as an over-the-counter supportive option.

• Treatment options discussed included topical minoxidil, low-level laser therapy, and PRP injections, should the patient wish to escalate treatment in the future.

3. Incidental Finding: Neoplasm of Uncertain Behavior

During the exam, we noted a darkly pigmented papule, with differential diagnoses including:

• Neoplasm of Uncertain Behavior

• Dysplastic Nevus

• Labial Melanotic Macule

The patient declined immediate intervention. We discussed monitoring the lesion and advised her to contact us if it changes or new symptoms appear.

Conclusion

This case highlights the importance of a comprehensive approach to hair loss in women, especially when multiple diagnoses like alopecia areata and androgenetic alopecia co-exist. Early recognition and intervention, such as ILK injections, can effectively manage autoimmune hair loss, while supplements and ongoing evaluation can address chronic thinning.

Our team at Reena Jogi MD in Katy and Houston, Texas is committed to delivering personalized hair loss care with compassion and evidence-based treatments. For inquiries, you may call Honey C. at 713-487-4061