Treating Telogen Effluvium and Seborrheic Dermatitis in a 52-Year-Old Female Patient in Katy & Houston, Texas
At Reena Jogi, MD, we see many women experiencing hair shedding and scalp irritation that impact both appearance and confidence. This case highlights a 52-year-old female patient from the Katy and Houston, Texas area presenting with moderate, gradual hair loss and symptoms consistent with telogen effluvium, seborrheic dermatitis, and folliculitis.
Patient Background
The patient reported years of progressive hair thinning on the scalp, eyebrows, and eyelashes, without scalp pain or itching. She washes her hair every other day and had not been using any treatments.
She had a history of estrogen and testosterone pellet therapy for three years, which she stopped 18 months ago due to cystic acne. Hair loss worsened after stopping the pellets. She is currently using an estrogen patch.
Clinical Findings
On examination:
Diffuse hair shedding, most noticeable in the mid-frontal scalp
Pink/orange scaly plaques on the scalp consistent with seborrheic dermatitis
Signs of folliculitis
Diagnosis
Telogen Effluvium (TE) – Likely triggered by hormonal changes following cessation of hormone pellet therapy.
Seborrheic Dermatitis – Chronic inflammatory scalp condition with visible scaling.
Folliculitis – Localized scalp inflammation with small pustules.
Treatment Plan
For Telogen Effluvium:
After an in-depth discussion of treatment options, including topical/oral minoxidil, spironolactone, supplements, low-level laser therapy, and platelet-rich plasma (PRP), the patient chose:
Oral Minoxidil 1.25 mg daily (½ tablet of 2.5 mg)
Spironolactone 50 mg twice daily
She was counseled on potential side effects for both medications, the importance of potassium monitoring while on spironolactone, and the possibility of an initial shedding phase with minoxidil use during the first 8–10 weeks.
The benefits of PRP therapy were also reviewed, including pricing options and the potential for enhanced results when combined with low-level laser therapy.
For Seborrheic Dermatitis & Folliculitis:
Ketoconazole 2% shampoo – three times weekly
Fluocinonide 0.05% solution – twice daily during flares (limited to 2 weeks per month)
Clindamycin 1% topical solution – once daily to affected areas
Alternating OTC anti-inflammatory shampoos (tar, selenium sulfide, or zinc pyrithione)
Patient education included chronic nature of seborrheic dermatitis, flare prevention strategies, and safe topical steroid use to minimize side effects such as skin thinning or pigment changes.
Follow-Up Plan
The patient will return in 3 months for a focused visit to assess treatment response, medication tolerance, and lab monitoring for spironolactone therapy.
Why This Case Matters for Women in Katy & Houston
This case demonstrates the importance of identifying the root cause of hair shedding—in this patient, hormonal changes after stopping long-term hormone therapy—and addressing coexisting scalp conditions like seborrheic dermatitis.
At Reena Jogi, MD, we use a comprehensive and personalized approach that often combines oral medications, scalp therapies, and advanced treatments like PRP and laser therapy to achieve optimal results.
Key Takeaways:
Hormonal changes can trigger telogen effluvium in women.
Combination therapy may address both hair shedding and scalp inflammation.
Early intervention and close follow-up improve the chances of successful regrowth.
