Case Report: Managing Cancer-Related Hair Loss in a 68-Year-Old Female with Androgenetic Alopecia and Telogen Effluvium
Hair loss in older women is often multifactorial and deeply personal. At Reena Jogi MD Dermatology in Houston and Katy, Texas, we provide nuanced, individualized care for patients with chronic, treatment-resistant hair loss—especially those navigating complex medical histories, like cancer.
This case report describes a 68-year-old female patient with generalized, gradual hair loss that began following cancer treatment, ultimately diagnosed as androgenetic alopecia (AGA) with telogen effluvium (TE) and coexisting seborrheic dermatitis.
Chief Complaint: Progressive Hair Thinning Over 3 Years
The patient presented with a 3-year history of moderate, generalized scalp hair thinning. The hair loss began after the initiation of oncologic treatment in 2022 and has persisted since. She was not on any current hair loss treatments and expressed concern about continued shedding and scalp irritation.
Examination Findings and Diagnosis
Dermatoscopic and clinical examination revealed:
Diffuse, non-scarring hair thinning across the scalp
Positive hair pull test at the posterior mid-parietal scalp (suggestive of telogen shedding)
Pink/orange scaly plaques indicating seborrheic dermatitis
Based on these findings, the patient was diagnosed with:
Androgenetic Alopecia (L64.8)
Telogen Effluvium (L65.0)
The patient’s history of breast cancer limited certain treatment options like oral finasteride, but we offered a broad range of alternatives.
Personalized Treatment Plan
1. Oral and Topical Minoxidil
After thorough counseling, the patient chose to begin:
Oral minoxidil (2.5 mg, half tablet daily, pending PCP approval)
Topical minoxidil 5% foam and solution for local stimulation
We extensively discussed side effects of oral minoxidil, including fluid retention, dizziness, and unwanted facial hair growth. The patient demonstrated understanding and agreed to proceed cautiously.
2. Low-Level Laser Therapy and Supplements
As part of her ongoing care, the patient was also encouraged to consider:
Low-level laser therapy (LLLT) for follicular stimulation
Supplements such as Nutrafol, Viviscal, or Votesse for nutritional support
3. Seborrheic Dermatitis Management
To address scalp inflammation, the following were prescribed:
Ketoconazole 2% shampoo, used at least three times weekly
Fluocinonide 0.05% solution, applied twice daily during flares (limited to 2 weeks/month)
OTC anti-inflammatory shampoos (alternated with prescriptions)
Patient Education and Expectations
We counseled the patient extensively on:
The chronic, progressive nature of AGA in post-menopausal women
The potential for hair regrowth and stabilization with consistent therapy
The recurring flare pattern of seborrheic dermatitis and how to manage it
Since she is still on cancer-related medications, we acknowledged their ongoing role in hair thinning and will monitor her response closely.
Conclusion: Compassionate Hair Loss Care for Complex Medical Cases
This case exemplifies our approach to managing post-cancer, hormonally-driven, and inflammatory scalp disorders. Through a balanced combination of evidence-based therapies, patient education, and long-term support, we help patients reclaim control over their appearance and confidence.
If you or a loved one is experiencing chronic hair loss in Houston or Katy, schedule a consultation with Reena Jogi MD to explore personalized treatment options.
