Case Report: Hair Loss, Allergic Contact Dermatitis, and Seborrheic Dermatitis in a 44-Year-Old Female | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Patients often present to dermatology clinics with more than one skin or hair concern. At Village Dermatology in Katy and Houston, Texas, we take a comprehensive approach, addressing each condition with both medical treatment and patient education. This case highlights a 44-year-old female with generalized hair loss, seborrheic dermatitis of the scalp, and allergic contact dermatitis affecting her toes.

Patient Presentation

The patient is a 44-year-old female who sought a second opinion for hair loss. She had been on oral minoxidil (half a tablet daily) for three months without noticeable improvement. In addition, she reported:

• Recurrent rashes on her toes triggered by beach visits (suspected allergic contact dermatitis)

• Scalp scaling and itching consistent with seborrheic dermatitis

Examination

A focused exam revealed:

• Diffuse thinning of scalp hair, consistent with female pattern hair loss

• Well-demarcated, geometric eczematous patches on toes consistent with allergic contact dermatitis

• Scaling and erythema on the scalp, consistent with seborrheic dermatitis

The patient was otherwise well-developed, oriented, and in no acute distress. A dermatoscope was used for scalp evaluation.

Impressions & Treatment Plan

1. Allergic Contact Dermatitis (L23.9)

• Triggered by beach exposure, etiology unclear

• Prescribed clobetasol 0.05% cream, applied BID during flares (up to 2 weeks/month)

• Counseling provided on hypoallergenic products, potential need for patch testing, and steroid side effects

2. Seborrheic Dermatitis

• Chronic scalp condition with flares

• Prescribed ketoconazole 2% shampoo, used daily during flares and 1–3 times weekly for maintenance

• Prescribed fluocinonide 0.05% solution, BID PRN during flares

• Counseling on long-term management, stress as a trigger, and steroid side effects

3. Androgenetic Alopecia (Female Pattern Hair Loss, L64.8)

• Patient counseled that 3 months of oral minoxidil is too early for results (typically 6–12 months needed)

• Treatment plan updated:

  • Continue oral minoxidil

  • Add oral finasteride 5 mg daily

  • Discussed additional options: PRP (platelet-rich plasma), AlmaTED treatments, supplements (Nutrafol, Viviscal), and at-home red light therapy

• Counseling on expectations: Female pattern hair loss is genetically determined, slowly progressive, and typically presents with widened midline parting while maintaining the frontal hairline

Conclusion

This case highlights the importance of comprehensive dermatology care in managing overlapping skin and hair conditions. At Village Dermatology in Katy and Houston, TX, our specialists combine advanced medical treatments, patient education, and cosmetic options to provide tailored care for conditions like hair loss, seborrheic dermatitis, and allergic contact dermatitis.