Case Report: Managing Chronic Telogen Effluvium in a 73-Year-Old Female
At our dermatology clinic in Houston and Katy, Texas, we frequently see patients struggling with persistent hair shedding. This case highlights the management of chronic telogen effluvium (TE) in an older woman who had previously undergone advanced treatments.
Patient Presentation
A 73-year-old female presented for follow-up of diffuse hair shedding on the posterior mid-parietal scalp. She had been diagnosed with telogen effluvium and completed one Alma TED treatment, but reported increased hair shedding afterward.
Her current regimen included:
Finasteride
Spironolactone
Prior Alma TED session
Clinical Examination
On examination with dermoscopy, the scalp continued to favor chronic telogen effluvium. Findings included:
Positive hair pull test for telogen hairs
No erythema, scaling, or scarring
Treatment Plan
After an in-depth discussion of options, including transitioning to dutasteride, intralesional corticosteroid injections (ILK), and continuing Alma TED, the patient elected the following:
Discontinue finasteride and switch to dutasteride 0.5 mg daily
Proceed with Alma TED session #2 during the visit
Continue supportive therapies, including topical minoxidil as an adjunct if tolerated
Laboratory testing ordered to assess underlying factors
The patient was counseled on expected outcomes, side effects, and the gradual nature of regrowth. She was advised to follow up as needed to monitor response.
Patient Counseling
The patient was educated on:
Pathophysiology of telogen effluvium – often triggered by stress, illness, thyroid disease, or nutritional deficiencies
Expected course – TE is typically self-limited, though chronic cases may persist for months to years
Treatment options – including minoxidil, supplements (Viviscal, Nutrafol), low-level laser therapy, platelet-rich plasma (PRP), and Alma TED
Conclusion
This case illustrates the challenges of managing chronic telogen effluvium in older patients. By incorporating advanced therapies like Alma TED with medical management such as dutasteride, patients may experience improvement in hair shedding and density.
If you are struggling with diffuse hair loss in Houston or Katy, Texas, our clinic offers a wide range of treatment options, including medications, supplements, regenerative therapies, and laser-based solutions.
