Alopecia Areata and Female Pattern Hair Loss: Understanding Combined Hair Loss Conditions in Women
Hair loss in women is often more complex than many people realize. Some patients may actually have multiple types of hair loss occurring at the same time, making diagnosis and treatment more challenging.
Recently, a 54-year-old woman visited our Houston and Katy hair loss clinic for evaluation of persistent scalp thinning, patchy hair loss, and scalp tenderness that had been progressing for over a year.
Patient Case Overview
The patient presented with:
Focal and diffuse scalp hair loss
Moderate thinning
Hair loss present for approximately one year
Scalp tenderness and bumps
Increased stressors
Previous diagnosis of alopecia areata
The patient had previously tried and failed several treatments including:
Topical steroids
Medicated shampoos
Intralesional Kenalog (ILK) injections
She also reported prior steroid injection-related skin atrophy.
At the time of evaluation, the patient was already taking:
Oral Minoxidil 2.5 mg daily
Litfulo (Ritlecitinib) for approximately 6 months
She noted some improvement with oral minoxidil but minimal change with Litfulo alone.
Diagnosing Multiple Types of Hair Loss
During examination using dermoscopy, findings suggested a combination of:
Alopecia Areata (AA)
The patient demonstrated both patchy autoimmune-related hair loss and diffuse female pattern thinning.
Affected areas included:
Mid-frontal scalp
Crown and midline scalp
Occipital scalp
Postauricular scalp regions
A positive hair pull test indicated active shedding.
What Is Alopecia Areata?
Alopecia Areata is an autoimmune condition where the immune system attacks healthy hair follicles.
This may cause:
Patchy bald spots
Sudden shedding
Recurrent hair loss
Scalp sensitivity in some patients
Although alopecia areata is autoimmune, patients were counseled that it is usually not associated with major systemic disease, aside from possible links to:
Thyroid abnormalities
Vitamin D deficiency
Stress can also worsen autoimmune hair loss flares.
What Is Female Pattern Hair Loss?
Androgenetic alopecia is one of the most common causes of chronic hair thinning in women.
Typical features include:
Widening midline part
Crown thinning
Diffuse loss of density
Gradual progression over time
Unlike alopecia areata, androgenetic alopecia is driven largely by genetics and hormonal influences.
Many patients can develop both conditions simultaneously.
Litfulo (Ritlecitinib) for Alopecia Areata
Litfulo is an FDA-approved JAK inhibitor used to treat severe alopecia areata.
During counseling, patients are educated regarding possible side effects including:
Headache
Upper respiratory infections
Acne
Nausea
Diarrhea
Hives
More serious risks discussed may include:
Serious infections
Blood clotting disorders
Cardiovascular events
Elevated liver enzymes
Changes in blood counts
Patients taking Litfulo are advised to avoid live vaccines while on therapy.
After extensive discussion, the patient elected to continue Litfulo therapy.
Oral Minoxidil for Hair Regrowth
The patient also elected to continue oral minoxidil 2.5 mg daily.
Oral minoxidil helps stimulate hair follicles by:
Increasing scalp blood flow
Extending the hair growth phase
Supporting thicker regrowth
Patients are counseled regarding possible side effects including:
Swelling of the feet or ankles
Dizziness
Increased body hair growth
Rapid heartbeat
Fluid retention
Temporary shedding during the first several weeks may also occur.
Dutasteride for Female Pattern Hair Loss
Because examination also demonstrated androgenetic alopecia, treatment with oral dutasteride 0.5 mg daily was initiated.
Dutasteride works by blocking DHT (dihydrotestosterone), a hormone involved in follicle miniaturization and progressive hair thinning.
Potential side effects discussed included:
Breast tenderness
Low libido
Mood changes
Depression
The teratogenic risks of dutasteride were also reviewed in detail.
PRP and AlmaTED Hair Restoration
Additional cosmetic hair restoration options discussed included:
Platelet-Rich Plasma (PRP)
PRP uses the patient’s own growth factors to stimulate weakened follicles and improve scalp health.
AlmaTED Hair Restoration
AlmaTED is a non-invasive treatment designed to enhance scalp penetration and follicle stimulation to support healthier hair growth.
Patients were informed these treatments are cosmetic and typically not covered by insurance.
Why Early Treatment Matters
When multiple hair loss conditions overlap, early diagnosis becomes especially important.
Without treatment, patients may experience:
Progressive thinning
Larger patches of hair loss
Reduced regrowth potential
Chronic shedding
Combining therapies often provides the best opportunity for improvement.
Hair Loss Specialist in Houston and Katy, Texas
At Reena Jogi MD, we specialize in advanced diagnosis and treatment of complex hair loss disorders including:
Alopecia Areata
Female pattern hair loss
Autoimmune hair disorders
Scalp inflammation
Medication-related shedding
PRP hair restoration
JAK inhibitor therapy
Our clinic provides individualized treatment plans tailored to each patient’s specific diagnosis and goals.
If you are experiencing patchy hair loss, scalp tenderness, or progressive thinning, schedule a consultation with our Houston and Katy hair restoration clinic today.
