Case Report: 45-Year-Old Female with Androgenetic Alopecia and Seborrheic Dermatitis

Introduction

Hair loss in women is a common concern that can significantly impact self-confidence and quality of life. At our dermatology practice serving Houston and Katy, Texas, we often see patients with overlapping scalp conditions that contribute to hair thinning. This case highlights a 45-year-old female presenting with androgenetic alopecia (female pattern hair loss) and seborrheic dermatitis, both of which required tailored management.

Patient Case

A 45-year-old woman presented as a new patient with a two-year history of progressive, diffuse hair loss on the scalp. The hair loss was moderate in severity, gradual in onset, and persistent despite over-the-counter measures.

A scalp examination, including dermoscopy, confirmed diffuse thinning consistent with androgenetic alopecia (AGA). Additionally, the patient showed pink-orange, scaly plaques consistent with seborrheic dermatitis.

The patient’s general health was otherwise stable. She was alert, oriented, and in no acute distress.

Diagnosis

• Androgenetic Alopecia (Female Pattern Hair Loss)

• Seborrheic Dermatitis of the Scalp

Treatment Plan

A detailed discussion was held with the patient regarding the chronic and progressive nature of female pattern hair loss. We reviewed available treatments, including:

• Topical minoxidil 5%

• Oral minoxidil

• Spironolactone (anti-androgen therapy for women)

• Finasteride (in select female patients)

• Low-level laser therapy

• Nutritional supplements such as Nutrafol, Viviscal, and Xtress

• Platelet-rich plasma (PRP) therapy

• Alma TED hair restoration

After reviewing benefits and risks, the patient chose to begin spironolactone (with potassium and metabolic monitoring) and topical minoxidil 5%. She was advised to report any side effects such as dizziness, menstrual changes, or elevated potassium.

For seborrheic dermatitis, she was prescribed:

• Ketoconazole 2% shampoo (used three times per week)

• Fluocinonide 0.05% topical solution for flares (limited to 2 weeks per month)

• Alternating with over-the-counter anti-inflammatory shampoos containing zinc pyrithione, selenium sulfide, or tar-based ingredients

Educational handouts were provided, emphasizing that seborrheic dermatitis is a chronic condition with periods of remission and flare-ups, often triggered by stress.

Follow-Up

The patient will follow up in 6 months to assess hair growth and treatment response, with earlier review if she experiences worsening hair loss or scalp irritation. A 4–6 week check was also recommended for seborrheic dermatitis management.

Discussion

This case demonstrates the importance of identifying and treating co-existing scalp conditions. In women, androgenetic alopecia often overlaps with scalp inflammation such as seborrheic dermatitis. Treating both conditions simultaneously helps create a healthier scalp environment and supports better hair restoration outcomes.

At our dermatology practice in Katy and Houston, Texas, we provide comprehensive evaluation and individualized treatment plans for patients struggling with hair loss.