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

Ciupińska, Magdalena; Skibińska, Justyna; Sikora, Mariusz; Blicharz, Leszek; Kotowska, Maja; Rudnicka, Lidia

doi:10.1159/000511577

Cited by 4 publications

(3 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings are consistent with the current literature ( 34 ), and SA could also be considered a “great imitator” on trichoscopy. However, the absence of exclamation mark hairs, a trichoscopic hallmark of alopecia areata, may be an important clue to the diagnosis since this feature has never been demonstrated on trichoscopy of SA ( 20 , 34 ). Further comparative studies with other types of alopecia are required to determine the most useful features.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The pathogenesis of both leukoderma and syphilitic alopecia is based on an immune response to Treponema Pallidum , with resulting loss of terminal hairs, stoppage of the hair cycle and hair bending in the case of alopecia, and melanin loss in the leukoderma [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Secondary syphilis presenting with alopecia and leukoderma in a stable HIV-positive patient in a resource-limited setting: a case report

Khumalo,

Mafulu,

Williams

et al. 2024

AIDS Res Ther

View full text Add to dashboard Cite

Background Syphilis is an infection caused by the bacteria Treponema pallidum. It is mainly transmitted through oral, vaginal and anal sex, in pregnancy and through blood transfusion. Syphilis develops in primary, secondary, latent and tertiary stages and presents with different clinical features at each stage. Infected patients can remain asymptomatic for several years and, without treatment, can, in extreme cases, manifest as damage in several organs and tissues, including the brain, nervous tissue, eyes, ear and soft tissues. In countries with a high human immunodeficiency virus (HIV) burden, syphilis increases the risk of HIV infections. We report the case of a young HIV-positive black woman who presented with alopecia and hypopigmentation as features of secondary syphilis. Case presentation A virologically suppressed 29-year-old woman on Anti-retroviral Therapy (ART) presented with a short history of generalized hair loss associated with a non-itchy maculopapular rash and skin depigmentation on the feet. Limited laboratory testing confirmed a diagnosis of secondary syphilis. She was treated with Benzathine Penicillin 2.4MU. After receiving three doses of the recommended treatment, the presenting features cleared, and the patient recovered fully. Conclusion This case demonstrates the importance of a high index of clinical suspicion and testing for syphilis in patients presenting with atypical clinical features of secondary syphilis, such as hair loss and hypopigmentation. It also highlights the challenges in diagnosing and clinically managing syphilis in a resource-limited setting.

show abstract

“…1,18 Treponema pallidum is found in the perivascular and peribulbar regions and sometimes penetrates the follicular matrix. [24][25][26][27][28][29] Consequently, an immune reaction against treponemal antigens attacks hair follicles at the peribulbar region 17,18,[24][25][26][30][31][32] and may contribute to weakening affected hair shafts. Immune response against Treponema pallidum also causes small vessel vasculitis, which leads to subsequent loss of terminal hairs and arrest of the hair cycle.…”

mentioning

confidence: 99%

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

Tejapira,

Sakpuwadol,

Pomsoong

et al. 2023

CCID

View full text Add to dashboard Cite

Background Syphilitic alopecia (SA) and alopecia areata (AA) are two distinct conditions that frequently present diagnostic difficulties, especially when differentiating between them due to their similar clinical presentations. Trichoscopy may help in differential diagnosis, but a comparison between trichoscopic features of SA and AA is yet to be researched. Objective To compare trichoscopic features between SA and AA and determine their discriminative values. Methods Electronic medical records and trichoscopic images of patients diagnosed with SA or AA between January 2000 and February 2022 were retrieved. Trichoscopic features were statistically compared, and their discriminative values were demonstrated as sensitivity, specificity, predictive value, likelihood ratio, and area under the receiver operating characteristic curve (AUC). Results A total of 69 patients were included: 23 SA and 46 AA cases were matched with a 1:2 ratio. Black dots, broken hairs, pigtail hairs, exclamation mark hairs, tapered hairs, angulated hairs, and non-pigmented regrowing hairs were significantly more prevalent in AA than in SA (all P<0.05), whereas erythematous background was more prevalent in SA than in AA patients (P=0.008). Among the aforementioned trichoscopic features, exclamation mark hairs and non-pigmented regrowing hairs had a high positive likelihood ratio for AA (16.17 and 8.34, respectively); however, only exclamation mark hairs revealed high AUC (AUC=0.816). Conclusion Despite the presence of several similar trichoscopic features between SA and AA, trichoscopy can aid in distinguishing between the two diseases. Exclamation mark hairs are the only trichoscopic feature that can be used to differentiate patients with clinically suspicious SA from those with AA.

show abstract

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

Cited by 4 publications

References 13 publications

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

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

Secondary syphilis presenting with alopecia and leukoderma in a stable HIV-positive patient in a resource-limited setting: a case report

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

Contact Info

Product

Resources

About