Case Report: Managing Hair Loss, Folliculitis, and Rosacea in a 64-Year-Old Female
At our dermatology clinic in Houston and Katy, Texas, we frequently see patients with multiple overlapping skin and hair conditions that require a personalized and multi-faceted approach. This case highlights the management of androgenetic alopecia, scalp folliculitis, and rosacea in a postmenopausal woman.
Patient Presentation
A 64-year-old female presented with generalized hair loss that had been gradually worsening for years. She was not currently on treatment for hair loss. Additional concerns included scalp irritation and facial redness with pustules.
Her medical history included:
Menopause, no hormone replacement therapy
Hypertension managed with losartan
Clinical Examination
The examination revealed:
Scalp: Diffuse non-scarring hair loss with widened midline part, consistent with androgenetic alopecia (AGA)
Folliculitis: Follicular-based pustules on the scalp
Face: Erythematous papules and pustules on both cheeks, consistent with rosacea
Diagnosis
Androgenetic Alopecia (AGA)
Folliculitis
Rosacea
Treatment Plan
1. Folliculitis
Ketoconazole 2% shampoo: Apply 2–3 times weekly, leave on 5 minutes, then rinse.
Clindamycin 1% gel: Apply once or twice daily.
Fluocinonide 0.05% topical solution: Apply twice daily for 2 weeks, then reduce to 2–3 times weekly for flares.
Counseling: Use antibacterial or benzoyl peroxide washes; medication may bleach clothing; reduce frequency if irritation occurs.
2. Androgenetic Alopecia
Finasteride 5 mg daily prescribed.
Counseling included:
Genetics-driven, slowly progressive nature of AGA.
Treatment options: topical/oral minoxidil, spironolactone (not advised due to hypertension/losartan use), finasteride, dutasteride, supplements (Nutrafol, Votesse, Viviscal), low-level laser therapy, PRP, and Alma TED.
Expectations: Requires consistent use; results take months; initial shedding possible with minoxidil.
Baseline photos taken for follow-up in 6 months.
3. Rosacea
Doxycycline hyclate 20 mg BID prescribed.
Counseling included:
Avoid triggers such as heat, alcohol, spicy foods, and stress.
Side effects of doxycycline: GI upset, photosensitivity, risk of bacterial resistance with long-term high-dose use.
Sun protection: daily broad-spectrum sunscreen SPF 30+.
Cosmetic options: IPL and Vbeam laser, HydraFacial, and chemical peels for redness reduction.
Patient Counseling
The patient received detailed education about:
Hair loss management: Need for long-term therapy and multiple options available.
Scalp care: Combining antifungal shampoo, topical antibiotics, and corticosteroids for folliculitis.
Rosacea triggers and sun protection: Lifestyle modifications, daily SPF, and moisturizer use.
Conclusion
This case highlights the complexity of managing patients with co-existing hair and skin disorders. By combining medical and cosmetic approaches—including finasteride for androgenetic alopecia, topical therapy for folliculitis, and doxycycline with lifestyle counseling for rosacea—we aim to improve scalp health, reduce inflammation, and restore confidence.
If you are struggling with hair loss, scalp irritation, or rosacea in Houston or Katy, Texas, our dermatology team provides comprehensive care with advanced medical and cosmetic treatment options.
