Comprehensive Evaluation of Male Hair Loss: Androgenetic Alopecia, Acne Keloidalis Nuchae, and Seborrheic Dermatitis in Katy and Houston, Texas

Hair loss in men is often multifactorial and may be accompanied by inflammatory or scalp conditions that worsen shedding and scalp health. At Reena Jogi, MD, we specialize in identifying the underlying causes of hair loss and developing personalized treatment plans. This case highlights a 34-year-old male evaluated for chronic scalp hair loss with associated inflammatory scalp conditions.

Patient Presentation

A 34-year-old male presented as a new patient with a chief complaint of hair loss on the scalp. The hair loss was moderate in severity, gradual in onset, and had been present for several years. The patient denied contributing factors including anemia, thyroid disease, systemic illness, recent hospitalizations, surgeries, or weight changes.

The patient had Fitzpatrick Skin Type IV and appeared well developed, well nourished, alert, and in no acute distress. A focused examination of the face and scalp was performed with a medical assistant present.

Clinical Findings and Diagnoses

Androgenetic Alopecia

Scalp examination revealed diffuse, non-scarring, patterned hair loss, most prominent in the vertex and frontotemporal regions, consistent with androgenetic alopecia. There was no evidence of scarring or active inflammation.

The genetic and androgen-mediated nature of male pattern hair loss was discussed, along with the chronic and progressive course of the condition.

Acne Keloidalis Nuchae

The patient was also noted to have keloidal papules and pustules on the left superior occipital scalp, consistent with acne keloidalis nuchae (AKN). The etiology was reviewed, including the association with coarse or curly hair and follicular inflammation that can lead to scarring alopecia if untreated.

Seborrheic Dermatitis

Additionally, the patient exhibited pink to orange scaly plaques on the scalp, consistent with seborrheic dermatitis. The chronic, relapsing nature of this inflammatory scalp condition and its potential to exacerbate hair shedding were discussed.

Treatment Discussion

A comprehensive discussion was held covering medical, topical, oral, supplement-based, and procedural treatment options, including:

• Compounded topical minoxidil, tretinoin, and finasteride

• Oral minoxidil, including low-dose safety considerations and potential side effects such as initial shedding, dizziness, edema, tachycardia, and hypertrichosis

• Oral finasteride, including possible sexual and mood-related side effects

• Hair growth supplements such as Nutrafol and Xstresse

• Platelet-rich plasma (PRP) and AlmaTED® hair restoration

• Long-term expectations for genetic hair loss

Treatment Plan

Androgenetic Alopecia

The patient elected to initiate a custom compounded topical therapy, including:

• Minoxidil 7%

• Tretinoin 0.025%

• Finasteride 0.1%

Instructions: Apply to the scalp nightly (QHS)
The patient was counseled on the expected initial shedding phase and the importance of consistent use. Follow-up was planned in 6–9 months for reassessment.

Acne Keloidalis Nuchae

To reduce inflammation and prevent progression to scarring alopecia, the following regimen was started:

• Clindamycin 1% topical solution – apply to affected areas in the morning

• Fluocinonide 0.05% topical solution – apply to the scalp 2–3 times daily

Additional counseling included the role of oral tetracyclines, intralesional kenalog, benzoyl peroxide, topical retinoids, and laser hair removal in select cases.

Seborrheic Dermatitis

For long-term control of scalp inflammation and flaking, the patient was prescribed:

• Ketoconazole 2% shampoo – lather to scalp for 5–10 minutes and face for 2 minutes, then rinse; use 1–3 times weekly for maintenance

The patient was counseled on the chronic nature of seborrheic dermatitis, common triggers such as stress, and potential side effects of topical antifungal therapy.

Patient Counseling and Follow-Up

The patient received detailed counseling on:

• Hair and scalp care practices

• Expected disease progression and treatment timelines

• When to contact the office for worsening symptoms or medication side effects

Expert Hair and Scalp Care in Katy and Houston, Texas

At Reena Jogi, MD, we provide advanced evaluation and treatment for hair loss and scalp disorders using evidence-based, personalized care. If you are experiencing hair thinning, scalp inflammation, or chronic shedding, expert dermatologic care is available in Katy and Houston, Texas.

☎ Call us today to schedule your appointment at 713-487-4061!