Why Is My Hair Still Getting Worse Even Though I Started Treatment for My Scarring Alopecia?
Hair loss can be particularly frustrating when it continues despite starting treatment. At Reena Jogi, MD in Katy, Texas and Houston, Texas, we frequently evaluate patients with complex hair loss conditions that require a combination of therapies and time to see improvement.
A recent patient asked during his follow-up visit:
“Why is my hair still getting worse even though I started treatment for my scarring alopecia?”
This case highlights the importance of early and consistent treatment for Central Centrifugal Cicatricial Alopecia (CCCA), especially when it occurs alongside androgenetic alopecia.
Case Report: 31-Year-Old Male with Progressive Vertex Hair Loss
A 31-year-old male returned for follow-up evaluation of central centrifugal cicatricial alopecia (CCCA) affecting the posterior mid-parietal scalp.
He was initially evaluated on January 16, 2025, and had been prescribed:
Topical tofacitinib lotion
Ketoconazole shampoo
Metformin ER 500 mg daily
The patient returned for reassessment due to:
Increased hair thinning at the vertex
Scalp itching
Small bumps on the scalp
He also reported frequent manipulation of his hair.
Dermatologic Examination in Katy & Houston, TX
A detailed scalp examination was performed.
Findings included:
Continued thinning at the crown
Inflammatory scalp symptoms
Pattern consistent with Central Centrifugal Cicatricial Alopecia
Coexisting androgenetic alopecia
We also discussed the possibility that hair manipulation and twisting behaviors could contribute to hair breakage or worsening hair loss.
Diagnosis 1: Central Centrifugal Cicatricial Alopecia (CCCA)
CCCA is a chronic inflammatory scarring hair loss condition that typically begins at the crown of the scalp and expands outward.
Without treatment, it can lead to permanent destruction of hair follicles.
Common symptoms include:
Hair thinning at the crown
Scalp itching
Tenderness or bumps
Gradual expansion of hair loss
Early treatment is critical to prevent permanent hair loss.
Diagnosis 2: Androgenetic Alopecia (Genetic Hair Loss)
In addition to CCCA, the patient also demonstrated features of androgenetic alopecia, which causes:
Patterned thinning
Follicle miniaturization
Progressive loss at the vertex and frontal scalp
When both conditions occur together, treatment often requires multiple approaches.
Why Hair Loss Treatments Take Time
The patient briefly tried oral minoxidil and metformin for only three days before stopping because he did not see improvement.
We counseled him that:
Hair growth cycles are slow
Most treatments require 3–6 months to evaluate effectiveness
Early discontinuation prevents adequate results
Consistency is essential for successful hair restoration.
Treatment Plan at Reena Jogi, MD
After reviewing all treatment options, the patient agreed to restart and continue therapy.
Updated Treatment Plan
✔ Oral Minoxidil 2.5 mg daily
✔ Topical Tofacitinib + Metformin compounded lotion
✔ Ketoconazole Shampoo
Leave on scalp for 5–7 minutes
Use on wash days
✔ Clobetasol scalp solution every other day
✔ Platelet-Rich Plasma (PRP) therapy
Baseline photographs were obtained for treatment monitoring.
Platelet-Rich Plasma (PRP) Treatment
The patient underwent PRP treatment #1 during the visit.
Procedure Details:
Blood was drawn in sterile fashion
Sample centrifuged to isolate platelet-rich plasma
7 cc of PRP injected into the scalp
Zimmer cooling device used for pain control
Patient tolerated the procedure well
PRP works by stimulating hair follicles with growth factors to improve hair density.
The patient will return in 1 month for PRP treatment #2.
Additional Diagnoses
Pseudofolliculitis Barbae
The patient also presented with razor bumps caused by hair growing back into the skin.
Recommendations included:
Avoid shaving hair too closely
Shave with the grain
Consider antibacterial washes or benzoyl peroxide
Laser hair removal may be curative
Mild Hair Manipulation Behavior
The patient reported frequent hair twisting and manipulation.
We discussed:
Risk of worsening hair loss
Potential benefit of N-acetyl cysteine (NAC) supplementation to reduce compulsive hair behaviors
Hair Loss Treatment in Katy, Texas & Houston, Texas
At Reena Jogi, MD, we specialize in diagnosing and treating complex hair loss conditions, including:
Central Centrifugal Cicatricial Alopecia (CCCA)
Androgenetic Alopecia
Scarring Alopecia
Hair loss associated with scalp inflammation
Hair loss requiring PRP or advanced therapies
Early diagnosis and consistent treatment are essential to prevent permanent hair loss.
If you’re experiencing progressive crown thinning, scalp itching, or scarring alopecia, schedule a consultation at our Katy or Houston dermatology clinic for a comprehensive hair loss evaluation.
