Chief complaint of hair l...

A 33-year-old female with H/o gastritis, depression, and obesity with a chief complaint of hair loss was presented to the dermatology clinic. She had been experiencing hair thinning for about one year with minimal improvement by using minoxidil 5% foam after three months. The patient had a pituitary microadenoma which got stable with treatment. All blood investigation reports were standard. 

Skin examination revealed diffuse nonscarring alopecia on the frontal scalp and vertex of the scalp, as shown in the figure. In addition, there were erythematous inflammatory papules and pustules on the face and mid to lower back, violaceous striae on the abdomen. The facial hirsutism and patches of coarse hypertrichosis on the back are shown in the figure. Based on subsequent tests reports: 24-h urine cortisol: 384 µg, dehydroepiandrosterone sulfate: 380 µg/dL, and ACTH: 76 pg/mL, the diagnosis was established.