Alopecia Areata Treatment in Women Planning Pregnancy
Patient Presentation
A 35-year-old woman presented as a new patient to Reena Jogi, MD with concerns of focal hair loss on the scalp. She reported moderate, patchy hair loss that began gradually approximately two months prior to presentation. The hair loss was localized to the left medial and central frontal scalp.
The patient had previously received intralesional Kenalog (ILK) injections one month earlier at an outside facility, with early signs of improvement. She was also taking vitamin D3 supplements and expressed interest in discussing safe treatment options, as she is planning conception within the next year.
Clinical Examination
A focused dermatologic examination was performed, including careful inspection of the scalp and hair using dermoscopy. The patient appeared well developed, well nourished, and in no acute distress.
Examination revealed focal, non-scarring patches of hair loss on the left frontal scalp, consistent with alopecia areata. Mild underlying scalp inflammation was also noted. A medical assistant was present during the examination as a chaperone.
Diagnosis
Based on the clinical findings, the patient was diagnosed with:
Alopecia Areata (Autoimmune, Non-Scarring Hair Loss)
Cutaneous Inflammation and Altered Skin Sensation
Seborrheic Dermatitis of the Scalp
Alopecia areata is an autoimmune condition characterized by sudden-onset patchy hair loss and commonly affects young to middle-aged women.
Treatment Plan
Intralesional Kenalog (ILK) Therapy
After discussing risks, benefits, and alternatives, the patient elected to proceed with another round of intralesional Kenalog injections during the visit.
Medication: Kenalog 2.5 mg/cc
Total Volume Injected: 1.0 cc
Number of Lesions Treated: 1
Treatment Number: 1
The risks of skin atrophy were reviewed in detail. ILK was medically necessary due to the lesion’s location, history of progression, and risk of recurrent irritation. The patient tolerated the procedure well and was advised to return in 6 weeks for reassessment and potential repeat injections.
Pregnancy Planning Considerations
Given the patient’s plans for pregnancy, counseling focused on treatments that are compatible with future conception. Intralesional corticosteroids are commonly used for alopecia areata and may be considered appropriate in select cases. The patient was advised to:
Continue coordination with her primary care provider
Check thyroid function and vitamin B12 levels, as autoimmune and nutritional factors can contribute to hair loss
Use topical minoxidil cautiously and discuss timing relative to pregnancy planning
Seborrheic Dermatitis Management
The patient also has a history of seborrheic dermatitis, which was well controlled. Examination showed pink-orange scaly plaques on the left scalp.
Management included:
Ketoconazole 2% shampoo, applied at least twice weekly
Counseling on chronic nature, flare triggers (including stress), and proper shampoo use
Counseling and Expectations
The patient was counseled that:
Alopecia areata often responds well to treatment, especially when addressed early
The condition can be recurrent, even after regrowth
Stress and immune triggers may contribute to flares
Close follow-up improves long-term outcomes
She was instructed to contact the office if hair loss worsens or fails to improve and to return in 6 weeks for follow-up ILK treatment.
Specialized Alopecia Areata Care in Katy & Houston, TX
At Reena Jogi, MD, we specialize in diagnosing and treating alopecia areata, including cases involving women planning pregnancy. Our approach emphasizes early intervention, individualized care, and safe treatment strategies to promote hair regrowth and long-term scalp health.
If you are experiencing patchy hair loss and are looking for an expert dermatologist in Katy or Houston, Texas, our team is here to help.
