Case Report: Managing Diffuse Hair Loss and Acne in a 30-Year-Old Female with PCOS
At our dermatology clinic serving Houston and Katy, Texas, we often evaluate patients with complex cases of hair loss. A recent visit from a 30-year-old female patient highlights the overlap between telogen effluvium, androgenetic alopecia, and underlying PCOS (polycystic ovarian syndrome)—all common contributors to hair thinning in women.
Patient Presentation
The patient reported gradual, diffuse hair loss that had been ongoing for several years. She washes her hair three times per week and experiences intermittent hair shedding, which she described as moderate in severity. She also noted a history of PCOS, a hormonal condition frequently linked to both androgenetic alopecia (female pattern hair loss) and telogen effluvium (stress-related hair shedding).
During her scalp examination, a hair pull test was positive, confirming the shedding pattern consistent with telogen effluvium. However, there were also signs of underlying androgenetic alopecia, with diffuse thinning across the scalp.
Diagnostic Considerations
Because hair loss in women can have multiple causes, we discussed performing a punch biopsy to further confirm the diagnosis. Triggers for telogen effluvium may include:
Stress or illness
Iron deficiency
Thyroid disease
Medications
Female pattern hair loss, on the other hand, tends to be genetically driven and slowly progressive, often presenting with a widened part while preserving the frontal hairline.
Treatment Options Discussed
Since the patient is planning pregnancy, many prescription therapies—such as oral minoxidil, spironolactone, and finasteride—are not safe to use. We carefully reviewed safe options, which included:
Topical Minoxidil 5% (over-the-counter)
Nutritional supplements such as Nutrafol or Viviscal
Low-level laser therapy devices (e.g., Theradome)
Platelet-rich plasma (PRP) therapy (cosmetic, not covered by insurance)
Gentle hair care and supportive scalp health measures
She was counseled that telogen effluvium is usually self-limiting and often resolves within months, while androgenetic alopecia tends to be progressive and may require long-term management.
Acne Management
In addition to hair loss, the patient reported stable acne involving the face and ear. She has seen improvement with azelaic acid cream and was prescribed topical clindamycin as part of her daily regimen. Gentle, non-comedogenic skin care products and sunscreen were also recommended to support acne control and prevent scarring.
Takeaway for Patients in Houston & Katy
This case demonstrates how women’s hair loss often involves more than one condition—in this case, telogen effluvium on top of androgenetic alopecia, with underlying PCOS as a contributing factor. Treatment decisions also depend on life plans such as pregnancy, which may limit available therapies.
At our clinic in Houston and Katy, Texas, we offer personalized treatment plans for female hair loss, acne, and hormonal skin conditions, including advanced therapies like PRP for hair restoration. If you are experiencing ongoing hair shedding, diffuse thinning, or treatment-resistant acne, a professional evaluation can help determine the right next steps.
