Epidemiological, Clinical, and Trichoscopic Features of Syphilitic Alopecia: A Retrospective Analysis and Systematic Review

Abstract

BackgroundSyphilitic alopecia (SA), which mimics other types of alopecia, is an uncommon manifestation of secondary syphilis. Trichoscopic features may facilitate its diagnosis. However, studies on SA and its trichoscopic characteristics remain limited.ObjectiveTo investigate the epidemiological, clinical, and trichoscopic findings and laboratory results, treatment, and outcomes of SA in Thai patients as well as to comprehensively summarize all trichoscopic features of SA through a systematic review.MethodsData on patients diagnosed with SA between December 2010 and December 2021 were obtained from their medical records and analyzed retrospectively. A systematic review of trichoscopic data, both from our institution and from studies registered in the PubMed, MEDLINE, and Embase databases, was conducted. A descriptive summarization was performed to comprehensively study the trichoscopic features of SA.ResultsOf the 205 patients with secondary syphilis, 23 patients with SA (symptomatic SA: 20, essential SA: 3) were included. The mean age was 27.6 ± 8.8 years, and male predominance was noted. The moth-eaten pattern was the most common SA presentation, and the parieto-occipital scalp was the most commonly affected area. All patients with SA achieved significant hair regrowth within 3 months of antibiotic therapy. Trichoscopic images were available for 20 patients with SA from our institute and were included in the systematic review. Fourteen articles provided information on 21 patients. Overall (N = 41), 26 (63.4%), 8 (19.5%), and 7 (17.1%) patients had moth-eaten alopecia, diffuse alopecia, and mixed alopecia, respectively. The most frequent trichoscopic finding was short regrowing hairs (78%), followed by decreased hair per follicular unit (75.6%), and empty follicles (51.2%). Unique features included flame hairs, bent tapering hairs, reddish-brown background, and brown rings around the perifollicular areas, each described in one case. However, the results were based only on case reports and small case series.ConclusionsGiven the progressively increasing frequency of SA, trichoscopic examination may be valuable when SA is suspected in patients with idiopathic alopecia; however, our findings are quite non-specific. The absence of exclamation mark hairs may help in the diagnosis of SA. Further comparative studies on other types of alopecia are required to determine the most useful diagnostic features.

Trichoscopic Features of Syphilitic Alopecia and Alopecia Areata: A Comparative Study

“…Results were consistent with those of previous studies that reported short regrowing hairs and black dots as the most prevalent trichoscopic signs for SA and AA, respectively. 5 , 18 , 21–23 Moreover, our findings support that trichoscopic signs of SA are nonspecific and overlap with those of AA. 18 , 23 Exclamation mark hairs, angulated hairs/zigzag hairs, and non-pigmented regrowing hairs provided high specificity and PPV of more than 90% towards AA.…”

“… 5 , 18 , 21–23 Moreover, our findings support that trichoscopic signs of SA are nonspecific and overlap with those of AA. 18 , 23 Exclamation mark hairs, angulated hairs/zigzag hairs, and non-pigmented regrowing hairs provided high specificity and PPV of more than 90% towards AA. However, only exclamation mark hairs showed high AUC, which favored the diagnosis of AA over SA.…”

“… 17 However, most trichoscopic features reported in SA are non-specific, and several findings overlap with those found in AA, such as tapered hairs, pigtail hairs, and zigzag hairs. 18 Currently, data regarding the comparison of trichoscopic characteristics between two conditions are limited. Therefore, this study aims to compare trichoscopic features between SA and AA and determine their discriminative ability.…”

Platelet-rich plasma in alopecia areata and primary cicatricial alopecias: A systematic review

“…Additionally, PRP impacts the anti-inflammatory effect by downregulating monocyte chemoattractant protein-1, matrix metalloproteinase (MMP)-3, MMP-13, and a disintegrin and metalloproteinase with thrombospondin motifs-5, and immunomodulatory properties by upregulating IL (interleukin)-4, IL-10, IL-13, and TGF-β ( 65 – 68 ). Furthermore, PRP may restore normal skin, prevent fibrosis, and remodel scar tissue ( 69 – 72 ).…”

Southern African HIV Clinicians Society Guideline for the clinical management of syphilis

“…Infection of the hair follicles resulting in alopecia of the scalp is present in approximately 10% of patients, and typically presents in a moth-eaten pattern ( Image 6 ). 33 Up to 10% of patients develop condylomata lata ( Image 7 ). 34 , 35 These lesions are mostly skin-coloured and are typically smooth, soft and flat, occurring in warm and moist areas such as the anogenital region, toe webs and oral cavity.…”