Sudden Focal Hair Loss in a 54-Year-Old Female: Understanding Alopecia Areata with Underlying Androgenetic Alopecia
At Reena Jogi MD Dermatology, we frequently encounter women experiencing unexpected or unexplained hair loss. In this case report, we present a 54-year-old woman from Houston, Texas, who developed sudden patchy hair loss on the back of her scalp—a presentation consistent with alopecia areata, with background signs of androgenetic alopecia.
🩺 Patient Background
The patient, a well-nourished, healthy 54-year-old woman, came in reporting a focal patch of hair loss that began one week prior. She was not currently receiving any hair loss treatments and had no scalp symptoms such as itching, pain, or redness.
🔎 Clinical Examination
On physical examination:
A sparse, discrete patch of hair loss was noted on the mid-occipital scalp.
There was no visible inflammation or scaling.
General scalp health appeared intact.
Background signs of diffuse thinning, consistent with androgenetic alopecia (AGA), were also observed.
The clinical diagnosis was alopecia areata, an autoimmune condition that causes sudden, non-scarring patches of hair loss.
💡 Understanding the Dual Diagnosis
Alopecia Areata:
Autoimmune in nature.
Causes localized, sudden hair loss.
Often responds well to intralesional steroid injections but can recur.
Androgenetic Alopecia:
Genetically driven and gradual in progression.
More common in post-menopausal women.
Often shows diffuse thinning with a widened part.
💉 Treatment Plan
1. Intralesional Kenalog (ILK) Injections:
To address the alopecia areata:
Six injections of Kenalog (triamcinolone acetonide) were administered directly into the sparse area.
Each injection delivered 2.5 mg/cc of medication.
The patient tolerated the procedure well and was counseled on potential side effects, including skin thinning (atrophy) at injection sites.
2. Nutraceutical Support for AGA:
Given the patient’s underlying androgenetic alopecia, she was counseled on long-term treatment options such as:
Low-level laser therapy
Oral spironolactone
However, as she was not bothered by overall thinning, she opted to begin with Nutrafol Women’s Balance, a targeted supplement for age-related hair changes.
🧬 Additional Dermatological Finding
A darkly pigmented papule on the lip was evaluated during the visit. While not currently causing concern, its differential diagnosis includes a melanotic macule or dysplastic nevus. The patient was given the option of a biopsy but declined treatment for now and will continue observation.
🗓️ Follow-Up Plan
The patient was scheduled to return in 1 month to assess response to ILK treatment and determine next steps, which may include repeat injections or consideration of additional hair regrowth therapies.
📍 Hair Loss Experts in Houston and Katy, Texas
Cases like this illustrate how hair loss can be multifactorial—even a new patch of hair loss can coexist with chronic genetic thinning. Early diagnosis and targeted intervention, including supplements like Nutrafol or procedures like Kenalog injections, can make a significant impact on outcomes. Our approach in both Houston and Katy, TX, is personalized and evidence-based.
If you're experiencing sudden or progressive hair loss, whether it's alopecia areata, androgenetic alopecia, or another condition, our board-certified dermatologist Dr. Reena Jogi provides state-of-the-art diagnostic and treatment options tailored to your needs. We proudly serve patients throughout Houston and Katy, TX with compassionate, cutting-edge care.
