The clinical and trichoscopic features of syphilitic alopecia

Abstract

Background: Syphilitic alopecia is not common in patients with secondary syphilis. Though the clinical and histopathological findings of syphilitic alopecia have been described, the trichoscopy features are unknown yet. Main observation:A 42-year-old Chinese man was admitted to our clinic with a complaint of hair loss. The patient presented clinically with moth-eaten alopecia over the whole scalp without any previous discomfort or skin rashes. The serology for syphilis was positive. Trichoscopy showed black dots, focal atrichia, hypopigmentation of hair shaft and yellow dots. Conclusions:On the basis of trichoscopy, along with serology testing syphilitic alopecia can be differentiated from other hair loss diseases with similar clinical presentation. (J Dermatol Case Rep. 2014; 8(3): 78-80) The clinical and trichoscopic features of syphilitic alopecia Yanting Ye, Xiaoting Zhang, Ying Zhao, Yugang Gong, Jian Yang, Huan Li, Xingqi Zhang Department of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, People's Republic of China. IntroductionSyphilis as a "great mimic" can present various manifestations indistinguishable from other diseases. Syphilitic alopecia is an uncommon clinical manifestation of secondary syphilis with an incidence of 2.9%-11.2%. 1,2The clinical manifestations and histopathological features of syphilitic alopecia have been described in detail, but the trichoscopic features of syphilitic alopecia have not been described yet. Here we present a case of syphilitic alopecia, and describe the clinical and trichoscopic features. Case reportA 42-year-old Chinese man came to our clinic with a complaint of hair loss for 2 weeks, without scalp pruritus or pain. He also complained about being under high mental stress recently. He was heterosexual and was engaging in casual sex. He denied having any skin lesions in the genital area before the hair loss, i.e., the clinical manifestations of primary syphilis. The patient had a past history of asthma and diabetes mellitus, but no history of hair loss.On physical examination of the scalp area, numerous small scattered non-scarring hairless patches with incomplete hair loss were observed. The patches were irregular in size without defined borders, ranged from 0.2cm-0.5cm in diameter, distributed over the whole scalp giving the appearance of moth-eaten alopecia (Fig. 1). The hairless areas showed no signs of inflammation or desquamation. The gentle pull test was negative. Under trichoscopy black dots, focal atrichia, hypopigmentation of hair shafts and yellow dots were observed (Fig. 2). The empty ostia of hair follicle were presented. No skin rash was found all over the body. Up till now, the primary clinical impressions include syphilitic alopecia (SA) and alopecia areata (AA).Blood tests were performed including blood count, total IgE, antinuclear autoantibodies tests, serology for HIV and syphilis. The results of serology for syphilis were positive: rapid plasma reagin test (RPR) with titer of 1:64...

The diagnostic value of trichoscopy in systemic sclerosis

“…Its' main advantages are diagnostic accuracy, repeatability, and opportunity to register outcomes. Trichoscopy is being used in different alopecias including scalp psoriasis, 26 syphilis, 27 pemphigous, 28 trichotillomania, 14 discoid lupus erythematosus. 14 There are some papers focusing on hair disorders in autoimmune diseases, however, systemic sclerosis was not yet adequate examined.…”

Infections, Infestations and Neoplasms of the Scalp

“…[SA] is an uncommon feature of secondary syphilis with an incidence of 2.9-11.2% [57]. The physical examination findings include numerous non-scarring, non-inflammatory, irregular in size without defined borders, 'moth-eaten' patches of alopecia of the scalp [58].…”

“…Under trichoscopy black dots, focal atrichia, hypopigmentation of hair shaft and yellow dots are observed in the hair loss region. Alopecia areata, tinea capitis and trichotillomania differ from SA with absence of exclamation hair, coma hair, flame hairs or v-sign, respectively [57].…”

Trichoscopy of Diffuse Syphilitic Alopecia

“…4,5,[10][11][12] Literatürde, sifilitik alopesinin trikoskopik bulgularını inceleyen az sayıda olgu bildirilmiştir. 3,[6][7][8] Güve yeniği form daha sık görülmesi nedeniyle trikoskopisi de göreceli olarak daha sık tanımlanmış-tır. Diffüz tip SA'nın trikoskopisini tanımlayan bir yayında belirgin bir değişiklik saptanmamış, diğe-rinde ise saç yoğunluğunda azalma, sarı noktalar, kırık saçlar ve zigzag saçlar izlenmiştir.…”

“…6 Ye Y ve ark ise güve yeniği formunda SA'sı olan bir hastada trikoskopik olarak siyah noktalar, sarı noktalar, fokal atrişya, kıl şaftının hipopigmentasyonu ve boş foliküller bulgularını saptamıştır. 7 Sekonder sifilizli hastaların klinik ve dermoskopik özelliklerini inceleyen başka bir çalışmada 12 hastanın 5'inde SA saptanmış; 4 olguda güve yeniği (1 esansiyel, 3 semptomatik) form izlenirken, 1 hastada ise diffüz tip görülmüştür. 3 Bu yayında güve yeniği formu görü-len SA'lı olgularda aynı foliküler ostiumdan çıkan saç sayısında ve terminal saçlarda azalma, ciltte kır-mızı-kahverengi renk değişikliği, boş foliküller ve vellus saçlar saptanmıştır.…”