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

Abstract

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.

Keywords: Alopecia; Alopecia areata; Clinical dermatology; Syphilis; Trichoscopy.

Fig. 1

Alopecia areata-like patches in the patient with syphilis.

Fig. 2

Hypopigmented patches on the skin of the patient with syphilis.

Fig. 3

Syphilitic alopecia may mimic alopecia areata. Trichoscopy reveals predominant loss of hair and presence of yellow dots (asterisk). However, typical trichoscopic features of alopecia areata are absent. A few black dots can be present in the course of disease (red arrows). A single flame hair (green arrow) represents a nonspecific finding, probably due to the pulling of hair to cover the patches of hair loss.