Sudden Hair Shedding and Folliculitis in a 24-Year-Old Male: Understanding Telogen Effluvium and Early Hair Loss Treatment Options
Sudden hair shedding can be alarming—especially for young adults who have never experienced noticeable hair loss. At Reena Jogi MD in Katy and Houston, Texas, we frequently evaluate patients who develop rapid-onset shedding following stress, medical events, or medication changes. This case highlights a 24-year-old male presenting with sudden diffuse hair loss and scalp inflammation, illustrating how telogen effluvium and folliculitis may overlap and how early intervention can meaningfully change long-term outcomes.
Case Overview
A 24-year-old male presented for evaluation of acute-onset generalized hair loss, which began two months prior. The shedding was described as sudden, moderate in severity, and more noticeable over the mid-frontal scalp, where a positive hair-pull test supported the diagnosis of telogen effluvium (TE).
He also reported a history of scalp bumps, and examination confirmed folliculitis affecting multiple hair-bearing areas.
He was not using any hair-loss treatments at the time of presentation.
Clinical Examination
A comprehensive dermatologic exam included the scalp, face, neck, trunk, extremities, and nails. Key findings:
1. Telogen Effluvium
Diffuse shedding with telogen hairs easily extracted during hair pull test
Mid-frontal scalp thinning
Timeline consistent with a trigger in the prior 2–3 months
2. Folliculitis
Follicular-based pustules across several hair-bearing sites
Inflammatory scalp changes potentially worsening hair shedding
No systemic symptoms
Identifying the Trigger: Stress & Recent Medication History
The patient began a new, high-stress job in February, which aligns with the typical 8–12 week lag seen in telogen effluvium. He also recently completed a course of isotretinoin (Accutane) in June. While Accutane-induced TE is less common, it cannot be fully ruled out as a contributing factor.
Additionally, he has a family history of androgenetic alopecia (AGA), making him more susceptible to early male-pattern thinning. This emphasizes the importance of both treating the acute shedding and monitoring for long-term hereditary hair loss.
Diagnosis
1. Folliculitis
An inflammatory condition of the hair follicles, often triggered by bacteria, friction, or occlusion. When untreated, it can worsen hair shedding.
2. Telogen Effluvium
A temporary shift of hairs into the shedding phase, often brought on by:
Stress
Illness
Medications
Hormonal shifts
Nutritional issues
In this case, stress was the most likely trigger, with recent isotretinoin therapy considered a secondary factor.
Treatment Plan
1. Folliculitis Management
To reduce inflammation and bacterial activity, the following regimen was initiated:
Doxycycline 100 mg twice daily (short course)
Ketoconazole 2% shampoo 2–3× weekly
Clindamycin 1% gel as spot treatment
Benzoyl peroxide wash to prevent recurrence
Patient education included sun-sensitivity counseling and avoidance of lying down for one hour after taking doxycycline.
2. Telogen Effluvium & Early Androgenetic Alopecia Support
Because the patient was shedding significantly and at risk for developing androgenetic alopecia, treatment focused on both stopping the acute shedding and protecting long-term hair density.
He elected to start:
Finasteride 1 mg daily
These therapies:
Improve hair growth
Reduce ongoing shedding
Help preserve density in patients with underlying genetic predisposition
Baseline photos were taken, and follow-up was scheduled for 6 months.
Prognosis
Telogen effluvium is highly reversible, and most patients see improvement within 3–6 months after triggers have stabilized. With the combination of:
Folliculitis control
Oral minoxidil
Finasteride
Consistent scalp care
…this patient is expected to experience significant stabilization and regrowth.
Patients with a family history of male-pattern hair loss benefit from early and proactive treatment—as seen in this case.
Dermatology Care for Hair Loss in Katy & Houston, Texas
At Reena Jogi MD, we specialize in diagnosing and treating complex causes of hair loss, from telogen effluvium to androgenetic alopecia, folliculitis, and more. Sudden shedding can feel overwhelming, but timely evaluation and targeted therapies can dramatically improve outcomes.
If you're experiencing rapid or unexplained hair loss, our team in Katy and Houston is here to help.
