Managing Severe Alopecia Areata in an 18-Year-Old Patient With Ophiasis Pattern Hair Loss
Alopecia areata is one of the most challenging autoimmune hair loss conditions, especially when it begins in early childhood and progresses into the more treatment-resistant ophiasis pattern. At Reena Jogi MD in Katy and Houston, Texas, we frequently manage complex cases like the one detailed below—highlighting how evolving therapies, combination approaches, and close monitoring can offer new hope for long-term regrowth.
Patient Background
An 18-year-old female, established with our clinic, presented for follow-up evaluation of generalized, sudden-onset hair loss. Though the current flare has been ongoing for years, her alopecia areata originally began at age 4. Throughout her childhood and adolescence, her condition remained relatively stable but has significantly worsened in the last 1–2 years.
Current Therapies Prior to Today’s Visit
Despite consistent treatment, progression continued while using:
Intralesional steroid (ILK) injections
Oral corticosteroids
Topical corticosteroids
Daily Allegra
Nutrafol supplements
The worsening course prompted revisiting and updating the treatment plan.
Clinical Examination
A comprehensive exam was performed, including:
Full scalp and hair inspection
Head, face, neck, conjunctiva, lids, and lips examination
General Findings
Well-developed, well-nourished
Alert and oriented ×3
Mood and affect appropriate
No acute distress
Baseline clinical photographs were taken to document disease severity and monitor future response.
Diagnosis: Alopecia Areata – Ophiasis Pattern
The patient continues to demonstrate alopecia areata, specifically the ophiasis subtype, which presents as band-like hair loss along the sides and lower posterior scalp. This variant is known to be more resistant to traditional therapies and more prone to persistent activity.
The recent worsening despite topical, oral, and injectable steroid therapy makes escalation of care medically appropriate.
Treatment Options Discussed
We reviewed all advanced treatments supported by current evidence:
1. Contact Immunotherapy (Squaric Acid)
Works by redirecting immune activity at the hair follicle
Requires ongoing in-office treatments
Useful for chronic or resistant cases
2. Platelet-Rich Plasma (PRP) Therapy
Uses the patient’s own concentrated platelets
Stimulates hair follicles
Effective as a combination therapy
No downtime and minimal side effects
3. JAK Inhibitors: Olumiant (baricitinib) & Litfulo (ritlecitinib)
FDA-approved for severe alopecia areata
Can lead to significant regrowth
Require baseline TB testing
Side effects and monitoring requirements were thoroughly reviewed
4. Oral Minoxidil
Recommended as an adjunct for improved regrowth
Often used to support PRP or JAK inhibitor regimens
Discussed risks, benefits, and expected timeline
After a thorough discussion, the patient and her mother decided on PRP therapy combined with oral minoxidil.
Medication Counseling
Oral Minoxidil
We discussed the risks of oral minoxidil, including:
Shortness of breath
Chest pain
Ankle swelling
Fast heart rate
Low blood pressure
Dizziness or lightheadedness
Unwanted facial or body hair growth
The patient demonstrated full understanding and agreed to proceed.
Final Treatment Plan
✔ Oral Minoxidil
Minoxidil 2.5 mg tablets
Take ½ tablet by mouth once daily
Normal to experience increased shedding during the first 8–10 weeks
✔ Continue Allegra Daily
✔ Start PRP Therapy
PRP Session #1 completed today
Procedure summary:
Blood drawn via butterfly needle
Processed in sterile tubes
Centrifuged to isolate PRP
7 cc of PRP injected subdermally to affected scalp areas
Pain control provided with Zimmer
Procedure well-tolerated without complications
Post-Procedure Instructions
Wash hair in warm water
Use sulfate-free shampoo
Avoid hair dye for 2–3 days
Continue all prescribed hair loss treatments, including topical minoxidil (if used)
Follow-Up Plan
Return in 1 month for PRP Session #2 and response evaluation.
Conclusion
This case illustrates the complexity and chronicity of alopecia areata, especially in its ophiasis form. With the introduction of PRP therapy and adjunctive oral minoxidil, this patient now begins a modernized, evidence-based treatment path with potential for meaningful regrowth.
At Reena Jogi MD in Katy and Houston, Texas, we are committed to offering the latest therapeutic options for autoimmune and genetic hair loss—helping patients regain confidence and long-term scalp health.
