Case Report: Managing Persistent Dandruff and Early Hair Thinning in a Young Male
Village Dermatology | Katy & Houston, Texas
Overview
A 19-year-old male presented to Village Dermatology with ongoing concerns of persistent dandruff and scalp itching, along with early signs of hair thinning near the frontal hairline. These issues had been present for several months and were beginning to affect daily comfort and confidence.
This case highlights the importance of identifying seborrheic dermatitis as a chronic inflammatory condition while also addressing early androgenetic alopecia with appropriate counseling and treatment planning.
Clinical Findings
On examination, the scalp demonstrated:
Diffuse scaling and flaking
Areas of excoriation from scratching
Involvement of the scalp and central facial regions
Hair examination also revealed patterned thinning along the frontal hairline and posterior mid-parietal scalp, consistent with early androgenetic alopecia, a common hereditary form of hair loss in young men.
The patient was otherwise healthy, well-appearing, and in no acute distress.
Diagnosis
Seborrheic Dermatitis of the Scalp (L21.8)
Androgenetic Alopecia (L64.8)
Both conditions were discussed in detail, including their chronic nature and tendency to fluctuate with triggers such as stress, sweating, and seasonal changes.
Treatment Plan for Seborrheic Dermatitis
A comprehensive treatment regimen was initiated to reduce inflammation, itching, and flaking while maintaining long-term control.
Prescribed therapies included:
Ketoconazole 2% shampoo (used 1–3 times weekly for maintenance)
Fluocinonide topical solution for short-term use during severe flares
Ketoconazole and hydrocortisone creams for facial and neck involvement
The patient was counseled to:
Allow medicated shampoo to remain on the scalp for 5–10 minutes before rinsing
Avoid applying oils or heavy moisturizers directly to the scalp
Use topical steroids only during flares to prevent side effects
Education emphasized that seborrheic dermatitis is chronic but manageable with consistent care.
Hair Loss Evaluation and Counseling
The patient also reported gradual thinning along the frontal hairline, consistent with male-pattern hair loss. He had been using a compounded topical minoxidil/finasteride formulation for approximately one year.
During the visit:
The genetic and progressive nature of androgenetic alopecia was reviewed
Treatment options including topical and oral minoxidil were discussed
Expected timelines for improvement (at least 6 months) were explained
After reviewing potential side effects and long-term expectations, the patient chose to continue topical therapy at this time. Educational materials on hair loss and PRP therapy were provided for future consideration.
Follow-Up Plan
4-week follow-up to reassess seborrheic dermatitis control
6-month follow-up for hair loss evaluation and treatment progression
Expert Dermatology Care in Katy & Houston
Persistent dandruff and early hair thinning are common concerns in adolescents and young adults. At Village Dermatology, we provide individualized treatment plans that address both medical scalp conditions and cosmetic concerns, helping patients achieve healthier skin and hair.
If you are experiencing itchy dandruff, scalp flaking, or early hair loss, our dermatology team in Katy and Houston, Texas is here to help.
