Managing Hair Loss, Seborrheic Dermatitis, and Acne in a 13-Year-Old Female

Written By Honey Cisneros

At our dermatology clinics in Houston and Katy, Texas, we frequently see young patients who present with more than one skin or hair concern. This case highlights a 13-year-old female with a combination of telogen effluvium, seborrheic dermatitis, and acne, and demonstrates the importance of a comprehensive treatment plan.

Patient Presentation

The patient returned for follow-up after being previously seen for hair shedding and facial acne. She had been using rosemary oil and Vegamour hair serum for hair loss and tretinoin 0.025% cream for acne. Despite these measures, she continued to notice shedding and acne flares.

Clinical Findings

On examination, the patient had:

  • Telogen Effluvium (TE): Positive hair pull test with diffuse hair shedding on the scalp.

  • Seborrheic Dermatitis (Seb Derm): Pink/orange scaly plaques on the scalp.

  • Acne: Inflammatory papules, pustules, and comedones across the face.

Lab testing was ordered to evaluate for potential triggers of TE, including thyroid function, iron deficiency, vitamin levels, hormone levels, and autoimmune screening.

Treatment Plan

1. Telogen Effluvium

We educated the patient and family about the self-limited nature of TE, while also addressing supportive treatment options.

  • Recommended: Topical Minoxidil 5% solution

  • Future Considerations: Supplements (Nutrafol, Viviscal), spironolactone (discussed but deferred until appropriate age/indication), low-level laser therapy, or PRP therapy.

  • Next Step: Blood work to identify and correct possible internal triggers such as iron deficiency or thyroid imbalance.

2. Seborrheic Dermatitis

A dual treatment strategy was implemented:

  • Ketoconazole 2% shampoo – use at least 3 times per week.

  • Fluocinonide 0.05% solution – apply twice daily during flares (limit to 2 weeks per month).

  • Over-the-Counter shampoos alternating with medicated options for maintenance.

3. Acne

Her acne regimen was adjusted for improved results:

  • AM Routine: Wash with Plexion Cleanser → Apply Azelaic Acid 15% gel → Moisturizer with SPF 30+

  • PM Routine: Wash with Plexion Cleanser → Apply Tretinoin 0.025% cream → Moisturizer

Counseling was provided regarding irritation risks, proper application, and realistic expectations—most patients see 60–80% improvement after 2–3 months.

Takeaway for Patients in Houston & Katy

This case illustrates the multifactorial nature of adolescent dermatology. Hair shedding, scalp inflammation, and acne often overlap and require a layered treatment approach. Early evaluation and intervention can not only improve physical symptoms but also reduce the psychological impact these conditions can have on teenagers.

At our Houston and Katy clinics, we provide personalized dermatology care for children and adolescents, addressing hair loss, acne, eczema, and other chronic skin conditions with safe and effective treatments.

Honey Cisneros
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