When hair loss is not just a cosmetic problem: Moth‐eaten alopecia in secondary syphilis

Hair loss is rare to be reported as sole manifestation of secondary syphilis. Syphilitic alopecia consists of symptomatic syphilitic alopecia that presents with other secondary syphilis manifestation, and essential syphilitic alopecia which can be patchy ("moth-eaten" type), diffuse, or combination without other manifestations of secondary syphilis. Here we report a case of secondary syphilis in patient with Human Immunodeficiency Virus (HIV) that present with moth-eaten alopecia as a sole manifestation. A 35-year-old male with HIV complained hair loss on his scalp and eyebrows. Physical examination showed non scarring moth-eaten alopecia on his scalp and lossof lateral third of his eyebrows without other lesions. Serological test for syphilis was positive. He was treated with 2.4 millions unit of benzathine penicillin G (BPG), single dose intramuscular injection. Six months after injection, patient showed clinical and serological improvement. Syphilitic alopecia cannot be ruled out in patients with non scarring hair loss with unclear etiology. Serological tests are recommended especially for patients with history of high risk sexual behaviour.

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Essential syphilitic alopecia: Non-scarring alopecia in 21-year-old man

Our Dermatology Online ◽

10.7241/ourd.2021e.2 ◽

2021 ◽

Vol 12 (e) ◽

pp. 1-3

Author(s):

Hafssa Chehab ◽

Bertrand Richert

Keyword(s):

Hair Loss ◽

Previous History ◽

Treponema Pallidum ◽

Clinical Manifestations ◽

Skin Lesions ◽

Secondary Syphilis ◽

Laboratory Evaluation ◽

History Of ◽

High Level

ABSTRACT Alopecia syphilitica is a less common clinical manifestations of secondary syphilis. It is uncommon for hair loss to be the sole or predominant manifestation, as hair loss is the chief clinical and histologic differential diagnosis of. The main difference between alopecia areata and Alopecia syphilitica is the detection of Treponema pallidum in syphilis. We present the case of a 21- year-old belgium man with different patches of non-cicatricial alopecia of his scalp. The patient denied previous history of genital or other skin lesions. Laboratory evaluation was positive for syphilis. The diagnosis of alopecia syphilitica was made and he was treated with single intramuscular injections of benzathine penicillin. The lesions improved with treatment in all the patients who attended follow-up. Dermatologists should maintain a high level of clinical suspicion for this uncommon manifestation of syphilis, particularly when it is the only symptom.

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Diffuse Hair Loss in Secondary Syphilis in HIV Positive Man: Case Report

Acta Facultatis Medicae Naissensis ◽

10.2478/v10283-012-0027-1 ◽

2012 ◽

Vol 29 (4) ◽

pp. 193-197 ◽

Cited By ~ 1

Author(s):

Milan Bjekić

Keyword(s):

Hair Loss ◽

Scalp Hair ◽

Secondary Syphilis ◽

Penicillin G ◽

Hiv Positive ◽

Oral Lesions ◽

Benzathine Penicillin ◽

Serological Tests ◽

Benzathine Penicillin G ◽

Macular Rash

SUMMARY Hair loss is not a common feature of secondary syphilis. There are two types of syphilitic alopecia: “symptomatic” type where hair loss is associated with other symptoms of secondary syphilis, and “essential” alopecia that is either patchy (“moth-eaten” type), diffuse pattern with a generalized thinning of the scalp hair, or a combination of both without any other mucocutaneous signs of syphilis. This article presents a case of syphilitic alopecia in a 30-year-old homosexual man. The patient had diffuse non-scarring alopecia of his scalp and loss of eyelashes and eyebrows. A macular rash with palmar-plantar involvement and oral lesions coexisted with the hair loss. Serological tests for syphilis were positive. The patient was treated with a single dose of benzathine penicillin G, 2.4 million units intramuscularly. Within three months there was dramatic hair regrowth, and all syphilitic lesions resolved. Patient was councelled and tested on HIV. The HIV seropositivity was confirmed by Western blot analysis. Syphilitic alopecia should not be overlooked in patients with non-scarring hair loss. Serologic testing for syphilis is recommended in patients with unexplained rapid hair loss. However, all patients presenting with syphilis should be offered HIV testing.

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Nonscarring Alopecia and Hypopigmented Lesions May Be Unusual Signs of Secondary Syphilis

Skin Appendage Disorders ◽

10.1159/000511577 ◽

2021 ◽

pp. 1-3

Author(s):

Magdalena Ciupińska ◽

Justyna Skibińska ◽

Mariusz Sikora ◽

Leszek Blicharz ◽

Maja Kotowska ◽

...

Keyword(s):

Hair Loss ◽

Alopecia Areata ◽

Early Stage ◽

Skin Lesions ◽

Secondary Syphilis ◽

Exclamation Mark ◽

Benzathine Benzylpenicillin

Noncicatricial patchy alopecia of the scalp and focal areas of skin hypopigmentation imply a diagnosis of alopecia areata and vitiligo. We present a case of a 22-year-old patient in whom these symptoms were associated with positive spirochete reactions, which allowed making a diagnosis of syphilitic alopecia coexisting with leukoderma syphiliticum. Skin lesions and hair loss resolved after the treatment with benzathine benzylpenicillin. Trichoscopy in syphilitic alopecia is nonspecific, but the absence of features typical for alopecia areata such as exclamation mark hairs may be important on an early stage of the clinical workup.

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