Case Report: Treating Focal Hair Loss from Alopecia Areata in a 33-Year-Old Male
Hair loss can take many forms—and not all are the typical male-pattern baldness. At Reena Jogi MD Dermatology, serving Houston and Katy, Texas, we often see patients with more complex forms of hair loss such as alopecia areata, an autoimmune condition. This case highlights a patient diagnosed with both alopecia areata and androgenetic alopecia, managed through a carefully customized approach.
Chief Complaint: Patchy, Sudden Hair Loss
A 33-year-old male presented with moderate, patchy scalp hair loss, which started suddenly about eight months prior, soon after a haircut. Unlike diffuse thinning, this hair loss was focal, affecting specific areas of the scalp. The patient was not using any current treatments at the time of evaluation.
Clinical Examination and Diagnosis
On examination, we noted discrete, non-scarring patches of hair loss across multiple scalp regions, including:
Left central frontal scalp
Right superior and central parietal scalp
Right superior postauricular skin
This pattern is consistent with alopecia areata, particularly the ophiasis variant, which affects the temporal and occipital scalp and is often more treatment-resistant.
The patient also showed signs of long-standing androgenetic alopecia (male pattern hair loss), identified through diffuse thinning on the vertex and frontotemporal areas.
Diagnosis Summary
Alopecia Areata (L63.8)
Androgenetic Alopecia (L64.8)
We discussed the autoimmune nature of alopecia areata, including common triggers like genetics, stress, or environmental factors. The patient appreciated the clear explanation of the dual diagnosis and elected to begin targeted treatment.
Treatment Plan: ILK and Topical Minoxidil
1. Intralesional Kenalog (ILK) Injections
To treat alopecia areata, we performed intralesional steroid injections using diluted Kenalog:
16 focal lesions injected
3.0cc total volume used
Patient tolerated the procedure well
Risks of skin atrophy were reviewed in detail
2. Topical Minoxidil for Androgenetic Alopecia
To address the patient’s long-term androgenetic hair thinning, we recommended:
Topical minoxidil, applied 1–2x daily
Continuation of low-level laser therapy at home
The patient preferred to avoid oral medications at this time and was advised to follow up in 6 weeks for reassessment.
Patient Education and Counseling
We provided in-depth counseling on both conditions:
For Alopecia Areata:
Treatment is often effective but may require long-term monitoring
Recurrence is possible due to the autoimmune mechanism
Additional options include topical immunotherapy or systemic therapies if needed
For Androgenetic Alopecia:
A genetically progressive condition affecting the crown and frontal scalp
Can be stabilized with minoxidil, finasteride, PRP, or laser therapy
Hair transplant may be considered in future if thinning progresses
Conclusion: Precision Treatment for Complex Male Hair Loss in Houston
This case illustrates the importance of differentiating between patchy autoimmune hair loss and patterned hereditary thinning—and treating each appropriately. At Reena Jogi MD Dermatology, we design personalized, effective regimens for every hair loss pattern, from PRP to steroid injections and cutting-edge topical solutions.
If you’re dealing with sudden hair loss or long-term thinning in Houston or Katy, schedule a consultation today.
