Complex Hair Loss in a 35-Year-Old Female – Alopecia Areata, Androgenetic Alopecia & Seborrheic Dermatitis
At Reena Jogi, MD, we often see patients presenting with more than one cause of hair loss, requiring a targeted and multi-layered approach. This case involves a 35-year-old female from the Katy and Houston, Texas area with sudden-onset patchy hair loss, long-standing thinning on the crown, and scalp inflammation from seborrheic dermatitis.
Patient Background
The patient reported:
Two-week history of sudden-onset bald patches on the scalp
Several years of gradual hair thinning on the crown
No current treatments prior to her visit
Her medical history and symptoms suggested a combination of autoimmune and genetic hair loss factors, along with a chronic inflammatory scalp condition.
Clinical Findings
On examination:
Discrete, non-scarring patches of hair loss on the posterior mid-parietal scalp and right superior parietal scalp (consistent with alopecia areata)
Diffuse thinning over the crown (consistent with androgenetic alopecia)
Pink/orange scaling on the scalp (consistent with seborrheic dermatitis)
Positive hair pull test in thinning areas
Diagnosis
Alopecia Areata – Autoimmune patchy hair loss
Androgenetic Alopecia – Chronic, progressive female pattern hair loss
Seborrheic Dermatitis – Inflammatory scalp condition
Treatment Plan
Alopecia Areata:
Intralesional Kenalog® injections (ILK) to reduce inflammation and stimulate regrowth in affected patches
Patient counseled on possible side effects including mild pain, skin atrophy, and pigment changes
Androgenetic Alopecia:
Discussed long-term treatment options including oral minoxidil, finasteride, spironolactone, topical minoxidil, low-level laser therapy, PRP, AlmaTED, and supplements
Patient elected to start Nutrafol® for hair support
PRP and AlmaTED discussed as possible future options
Seborrheic Dermatitis:
Ketoconazole 2% shampoo – lather 5–10 minutes before rinsing, 1–3 times/week
Fluocinonide 0.05% topical solution – for severe flares, applied twice daily as needed
Counseling on chronic nature of condition and safe topical steroid use to avoid side effects
Follow-Up Plan
4 weeks for reassessment of seborrheic dermatitis and alopecia areata response to ILK injections
Continue Nutrafol and scalp treatments
Consider adding PRP therapy in future visits
Why This Case Matters for Women in Katy & Houston
Many women experience overlapping causes of hair loss, such as autoimmune alopecia areata and hormonally driven androgenetic alopecia. This combination requires layered treatment strategies—managing immune response, supporting follicle health, and controlling scalp inflammation.
At Reena Jogi, MD, we provide personalized treatment plans tailored to each patient’s specific hair loss pattern, medical history, and cosmetic goals.
Key Takeaways:
Early treatment of alopecia areata improves regrowth chances
Combination hair loss causes require a customized plan
Scalp health directly impacts hair growth success
