Case Report: Chronic Hair Loss After COVID Leading to Androgenetic Alopecia and Early CCCA
Katy & Houston, Texas Hair Loss Specialist – Reena Jogi, MD
Patient Background
A 47-year-old female presented as a new patient to our hair loss clinic with concerns of progressive scalp hair thinning that had been ongoing for approximately three years. The patient reported that her hair loss began after a COVID-19 infection, at which time she was diagnosed with telogen effluvium (TE). While some regrowth occurred, she felt that her hair density—particularly at the crown and vertex scalp—never fully recovered.
She had previously tried multiple therapies, including oral and topical minoxidil, finasteride (Propecia), ketoconazole shampoo, Nutrafol supplements, and intralesional Kenalog (ILK) injections, which helped partially but did not fully restore crown density. She discontinued minoxidil and supplements about a year prior to her visit and felt her hair growth had since stalled.
Clinical Examination
A comprehensive scalp and hair examination was performed using dermoscopy. The patient was alert, well-nourished, and in no acute distress.
Key findings included:
Diffuse thinning with prominence at the crown and vertex
Positive hair pull test
Findings most consistent with androgenetic alopecia (AGA)
Early signs of central centrifugal cicatricial alopecia (CCCA) involving the central scalp
Given the mixed clinical picture of patterned hair loss, diffuse non-scarring alopecia, and early scarring changes, a punch biopsy was recommended to further confirm the diagnosis and guide long-term management.
Diagnosis
Androgenetic Alopecia (L64.8) – primary cause of ongoing thinning
Diffuse Non-Scarring Hair Loss – likely residual from prior telogen effluvium
Early Central Centrifugal Cicatricial Alopecia (L66.81) – affecting the central scalp/vertex
This case highlights how post-COVID hair shedding can unmask or accelerate underlying genetic and inflammatory hair loss conditions.
Treatment Plan
After an extensive discussion of treatment options, risks, benefits, and expectations, the patient elected to proceed with a multi-modal medical hair restoration plan, including:
Medical Therapy
Oral Minoxidil 2.5 mg daily
Oral Finasteride 5 mg daily (with detailed counseling on teratogenic risks)
Topical Minoxidil 12% with Tretinoin 0.025% solution applied daily
Fluocinonide 0.05% topical solution for scalp inflammation related to early CCCA
The patient was counseled extensively on:
Expected initial shedding with minoxidil
Possible side effects of oral minoxidil, finasteride, and spironolactone
The slow, progressive nature of androgenetic alopecia
The importance of long-term consistency with therapy
Advanced & Cosmetic Treatment Options Discussed
Because hair loss is often multifactorial, we also reviewed advanced therapies, including:
Platelet-Rich Plasma (PRP) therapy
AlmaTED™ regenerative hair restoration
Low-level laser therapy (LLLT)
The patient understood that these treatments are cosmetic and not covered by insurance, but may significantly improve hair density and scalp health, particularly in early CCCA.
Follow-Up & Prognosis
The patient will return in 6 months to reassess response to treatment and review biopsy results if performed. Early identification and treatment of AGA and CCCA offer the best chance for hair preservation and regrowth, especially when addressed by a board-certified dermatologist specializing in hair disorders.
Expert Hair Loss Care in Katy & Houston, Texas
At Reena Jogi, MD, we specialize in diagnosing and treating complex hair loss conditions, including post-COVID hair loss, androgenetic alopecia, CCCA, telogen effluvium, and scarring alopecias. Every patient receives a personalized, evidence-based treatment plan.
If you are experiencing hair thinning, shedding, or scalp changes, early evaluation is key.
