Case Report: Managing Androgenetic Alopecia and Seborrheic Dermatitis in a 37-Year-Old Male
At our dermatology practice in Houston and Katy, Texas, we frequently treat men who experience long-standing hair loss alongside scalp conditions such as seborrheic dermatitis. This case highlights how combining medical therapies with supportive scalp care can improve both hair density and scalp health.
Patient Presentation
A 37-year-old male presented for evaluation of generalized hair loss that had been gradually progressive for several years. He had been on finasteride (Propecia) and oral minoxidil with initial stabilization, but noted worsening thinning over time.
In addition, the patient reported scalp irritation and flaking, consistent with seborrheic dermatitis.
Clinical Examination
Scalp: Diffuse thinning involving the vertex and frontotemporal scalp, consistent with androgenetic alopecia (AGA).
Scalp surface: Flaking and erythema in patches, consistent with seborrheic dermatitis.
Skin exam:
Benign nevus on left upper back, 2 mm, evenly pigmented and symmetrical.
Seborrheic keratosis on right forearm, appearing as a “stuck-on” brown papule.
Diagnosis
Seborrheic Dermatitis (Scalp)
Androgenetic Alopecia (Male Pattern Hair Loss)
Benign Nevus – monitored, no treatment required
Seborrheic Keratosis – benign, no treatment required
Treatment Plan
1. Seborrheic Dermatitis
Ketoconazole 2% shampoo: Lather into scalp 5–10 minutes, rinse, 1–3x/week.
Fluocinonide 0.05% solution: Apply twice daily for flares only.
Counseling: Chronic condition with remissions and flares, often triggered by stress. Avoid overuse of steroids due to risk of skin thinning and discoloration.
2. Androgenetic Alopecia
Transitioned from finasteride to dutasteride 0.5 mg daily for stronger DHT suppression.
Continued oral minoxidil 2.5 mg daily.
Counseling:
Initial shedding is normal in first 8–10 weeks with minoxidil.
Side effects of minoxidil: ankle swelling, low blood pressure, dizziness, unwanted hair growth.
Side effects of dutasteride: decreased libido, breast tenderness, mood changes.
Additional treatment options reviewed: supplements (Nutrafol, Viviscal, Votesse), PRP, Alma TED, and low-level laser caps.
3. Benign Nevi & Seborrheic Keratoses
Both lesions deemed benign; no intervention needed.
Recommended monthly self-skin checks and annual skin exams.
Emphasized daily use of sunscreen SPF 30+.
Conclusion
This case highlights the importance of multimodal treatment for patients with both hair and scalp concerns. By addressing seborrheic dermatitis with antifungal shampoo and anti-inflammatory topicals while optimizing treatment for androgenetic alopecia with oral minoxidil and dutasteride, patients can achieve improved scalp health and hair preservation.
If you are struggling with male hair loss or scalp irritation in Houston or Katy, Texas, our dermatology team provides advanced hair restoration options and medical-grade scalp care tailored to your needs.
