Syphilitic alopecia: uncommon trichoscopic findings

Abstract

Syphilitic alopecia (SA) is considered an uncommon manifestation of secondary syphilis. SA can present in a diffuse form, resembling telogen effluvium, or in a moth-eaten form that mimics a variety of conditions (i.e., alopecia areata, trichotillomania, lichen planus pilaris or tinea capitis). When the two forms coexist, we observe a mixed pattern. Essential SA manifests without evidence of mucocutaneous syphilis manifestations and its diagnosis is often delayed. To date, trichoscopic description of SA forms are based on very few cases (i.e., five patients with moth-eaten SA and one with diffuse SA). This is the first report of a mixed pattern of essential SA: some new trichoscopic features-such as tapered bended hairs, erythematous background, diffuse scaling and perifollicular hyperkeratosis-are described in a 32-year-old man. In the absence of secondary syphilis manifestations, dermoscopy can be a useful tool that helps suspect and differentiate SA from its common mimickers.

Keywords: moth-eaten and diffuse syphilitic alopecia; secondary syphilis; trichoscopy.

Figure 1

Clinical aspect. Diffuse alopecia involving the scalp and the eyebrows, with moth-eaten patches on the temporal, parietal and occipital regions. Diffuse fine scaling is present on the scalp. [Copyright: ©2017 Tognetti et al.]

Figure 2

Dermoscopy of the scalp. Empty ostia and yellow dots are visible in the center of the alopecic patches over an erythematous background. Tapered bent hairs (arrows) are present at the periphery of the alopecic patches. Vellus hair are visible at the periphery (a,b,d). Scales appear to be thin and withish; perifollicular hyperkeratosis is focally visible (b,c,d). [Copyright: ©2017 Tognetti et al.]

Figure 3

Clinical (a) and dermoscopic (b) appearance of alopecia areata. Multiple black and yellow dots and vellus hairs are observable at the periphery of the alopecic patch (a,b) along with some exclamation mark hairs (b). [Copyright: ©2017 Tognetti et al.]

Figure 4

Clinical (a) and dermoscopic (b) aspect of lichen planus pilaris alopecia. Confluent small alopecic patches of the parietal area are present on an erythematous scalp (a). Dermoscopy shows dilated capillaries and severe follicular hyperkeratosis at the periphery of the patch and absence of follicular ostia in the center (b). [Copyright: ©2017 Tognetti et al.]