Case Report: Evaluation of Hair Loss, Pigmentation, and Skin Lesions in a 37-Year-Old Male
At our dermatology practice in Houston and Katy, Texas, we frequently see patients presenting with multiple overlapping skin and hair conditions. This case demonstrates the careful evaluation and management of androgenetic alopecia, post-inflammatory hyperpigmentation, and suspicious skin lesions requiring biopsy.
Patient Presentation
A 37-year-old male presented as a new patient with three primary concerns:
Skin lesions on the forehead, cheek, and back, darkening over time.
Diffuse hair loss on the scalp, gradual in onset, worsening over several years.
Dark discoloration of the underarms.
Clinical Examination
A comprehensive exam with dermoscopy was performed. Findings included:
Axillae: Hyperpigmentation consistent with post-inflammatory hyperpigmentation (PIH).
Scalp: Diffuse thinning, most consistent with androgenetic alopecia (AGA).
Face and back: Dark patches; differential diagnosis included dermatitis, discoid lupus, or lichen planus.
Right postauricular skin: Lesion biopsied for further evaluation.
Diagnosis & Treatment Plan
1. Post-Inflammatory Hyperpigmentation (PIH)
HQ/Kojic Acid compound cream: Hydroquinone 12% with kojic acid 6% applied daily for 3 months.
Counseling:
Minimize sun exposure.
Use broad-spectrum sunscreen SPF 30+.
Possible side effects of hydroquinone include irritation, dryness, hypopigmentation, and rare paradoxical darkening (pseudoochronosis).
2. Androgenetic Alopecia (AGA)
Topical minoxidil 5% solution prescribed.
Counseling:
Genetic, progressive condition requiring long-term therapy.
Treatment options reviewed: oral minoxidil, finasteride, PRP, AlmaTED, supplements, and low-level laser therapy.
Patient elected to start with topical minoxidil.
Handout provided for further education.
3. Dermatitis vs. Discoid Lupus vs. Lichen Planus
Performed a 4 mm punch biopsy of the right postauricular lesion.
Biopsy sent for histopathology to clarify diagnosis.
Counseling on risks of biopsy, including scarring, infection, and incomplete removal.
Wound closed with nylon sutures; instructions given for suture removal in 9 days.
Patient Counseling
Discussed the gradual nature of improvement for pigmentation and hair loss.
Emphasized the importance of consistent treatment and follow-up.
Patient instructed to return in 2 weeks for biopsy results and in 6 months for hair loss follow-up.
Conclusion
This case highlights the importance of comprehensive dermatologic evaluation when patients present with multiple concerns. By addressing hair loss, pigmentation changes, and suspicious skin lesions simultaneously, we ensure that both cosmetic and medical aspects of care are properly managed.
If you are experiencing hair loss, pigmentation, or new skin lesions in Houston or Katy, Texas, our dermatology clinic provides advanced diagnostics and customized treatment options.
