Dual Diagnosis of Alopecia Areata and Androgenetic Alopecia in a 34-Year-Old Woman
Hair loss can be a distressing and confidence-impacting condition, especially when it occurs unexpectedly and is accompanied by chronic patterns. At Reena Jogi MD in Houston and Katy, Texas, we specialize in diagnosing and treating complex hair loss conditions. This case highlights a 34-year-old female patient who presented with two coexisting types of hair loss—alopecia areata and androgenetic alopecia (AGA)—and showcases a thoughtful, customized treatment strategy.
Patient Presentation
A 34-year-old woman arrived at our clinic with a sudden onset of generalized scalp hair loss that had persisted for several months. She denied any itching, burning, or other scalp symptoms and had not initiated any treatment prior to her visit. Her past medical history included polycystic ovary syndrome (PCOS), diagnosed in 2019, and recent initiation of oral contraceptive pills.
On examination, she displayed:
Discrete, non-scarring patches on the right posterior parietal scalp and superior scalp, consistent with alopecia areata.
Diffuse thinning across the crown and midline scalp, suggesting androgenetic alopecia.
A dermatoscopic exam and clinical review confirmed both diagnoses.
Diagnosis
Alopecia Areata (AA): An autoimmune condition resulting in patchy, non-scarring hair loss.
Androgenetic Alopecia (AGA): A genetically driven form of diffuse hair thinning, often linked to hormonal imbalance, including PCOS.
Treatment Plan
Given the dual nature of her hair loss, the treatment approach needed to address both inflammatory and hormonal components:
For Alopecia Areata:
Intralesional Kenalog Injections: Five areas were injected with diluted triamcinolone (Kenalog) at a concentration of 2.5 mg/cc for a total of 1.0 cc. Risks such as skin atrophy were reviewed, and the patient tolerated the procedure well.
For Androgenetic Alopecia:
Oral Spironolactone 50 mg BID: Prescribed to reduce the androgenic effects associated with PCOS.
Over-the-Counter Rogaine (Minoxidil 5% solution): Recommended for twice-daily use, with guidance provided on the expected timeline and potential initial shedding.
Nutraceutical Support: Nutrafol and Votesse were suggested to support scalp health and promote regrowth.
Platelet-Rich Plasma (PRP): The patient was educated on PRP therapy as a future option, with pricing and expectations discussed in detail.
Patient Education & Counseling
The patient was educated on the chronic and recurring nature of both conditions. Treatment expectations, proper topical application techniques, and side effects of oral medications were thoroughly reviewed. She was advised to monitor for symptoms such as dizziness, leg swelling, and menstrual irregularities, and to follow up in 6 weeks to evaluate response and consider repeat injections.
Why It Matters
This case is a powerful example of the importance of personalized dermatologic care. By recognizing the coexistence of AA and AGA, and layering both medical and cosmetic treatments, we provided the patient with a hopeful path forward. At Reena Jogi MD, we prioritize accurate diagnosis and multimodal therapies to restore confidence and achieve the best hair restoration outcomes. Schedule here.
