Complex Female Hair Loss: A 41-Year-Old Woman with Androgenetic Alopecia, Frontal Fibrosing Alopecia & Scalp Inflammation in Houston & Katy, TX
Provider: Reena Jogi MD – Hair Loss & Scalp Specialist | Houston & Katy, Texas
Hair loss can be complex—especially when multiple overlapping conditions are involved. We recently evaluated a 41-year-old woman at our Katy and Houston dermatology clinic with a 3-year history of progressive scalp hair thinning, accompanied by scalp itching, flaking, and inflammation.
Initial Concerns: Chronic Hair Loss & Scalp Irritation
This patient had not pursued formal treatment before, though she had previously seen a trichologist. She washes her hair 3 times weekly and noted scalp itching and flaking, in addition to the diffuse thinning. No family history of hair loss was reported.
Upon physical and dermatoscopic exam, the scalp showed signs of both diffuse hair miniaturization and mild frontal recession, consistent with androgenetic alopecia (AGA) and possible early frontal fibrosing alopecia (FFA). A positive hair pull test indicated active shedding.
Diagnoses:
Androgenetic Alopecia (Female Pattern Hair Loss)
Diffuse, non-scarring hair loss across the scalp
Midline part widening, but preservation of the frontal hairline
Early Frontal Fibrosing Alopecia (FFA)
Mild recession in the frontal scalp
A form of scarring alopecia more common in postmenopausal women but increasingly seen in younger females
Scaly, pink/orange plaques with itching and flaking
Frequently contributes to inflammation and worsens hair thinning
Treatment Plan: A Multi-Faceted Approach
Given the coexistence of inflammatory and hormonal scalp conditions, Dr. Reena Jogi designed a phased treatment strategy to address all three concerns.
✅ Hair Loss (AGA & FFA)
Topical Minoxidil – To support follicle health and promote hair regrowth
Spironolactone – A hormone-blocking medication used in female pattern hair loss
Biopsy Deferred – Patient declined scalp biopsy but may revisit after managing inflammation
Future Options Discussed – PRP therapy, oral minoxidil, finasteride, and AlmaTED reviewed
✅ Scalp Inflammation (Seborrheic Dermatitis)
Ketoconazole 2% Shampoo – To reduce yeast and scalp buildup
Fluocinonide 0.05% Solution – For short-term use during flares
Fragrance-Free Hair Products – Recommended to minimize irritation
Shampoo Rotation Plan – Provided list of anti-inflammatory OTC shampoos
📝 Counseling
The patient was educated on the chronic nature of all three conditions:
AGA is progressive and genetic
FFA may lead to permanent hair loss if not addressed early
Seborrheic dermatitis flares with stress, product use, or weather changes
Patient Outlook
This 41-year-old woman now has a comprehensive treatment plan targeting both hair loss and scalp inflammation. By controlling seborrheic dermatitis first, she can transition into longer-term solutions for female pattern hair loss and monitor for progression of FFA.
She will return in 3 months for a follow-up exam and to revisit biopsy or advanced therapies like PRP or AlmaTED.
