The Hair Loss Encyclopedia

Alopecia Areata in a Patient Undergoing Treatment for Secondary Syphilis: A Diagnostic Challenge

February 2026 in “ Cureus ”

Diego I Mendez-Villanueva, Ana Martinez, Diana Castro, Nicolas Opazo, Diego F. M. Guarda

alopecia areata syphilitic alopecia trichoscopy clobetasol exclamation mark hairs black dots AA SA

Studysummary This case report highlights that alopecia areata can mimic syphilitic alopecia in patients with recent or active syphilis, emphasizing the importance of trichoscopy in accurately diagnosing alopecia types and preventing misdiagnosis. Our plain-language summary of this paper — not a Tressless recommendation.

A 17-year-old male treated for secondary syphilis developed patchy scalp alopecia, initially suspected to be syphilitic alopecia (SA). However, trichoscopy indicated alopecia areata (AA) due to findings like exclamation mark hairs and black dots, without signs of SA. After six weeks of topical clobetasol treatment, significant hair regrowth was observed. This case emphasizes the importance of trichoscopy in distinguishing AA from SA, preventing misdiagnosis, and avoiding anchoring bias, especially in patients with recent syphilis.

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Research cited in this study

4 / 4 results

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

1 citations , August 2023 in “Clinical Cosmetic and Investigational Dermatology”

This study found that exclamation mark hairs are the only trichoscopic feature that can differentiate clinically suspicious SA from AA.

Syphilitic Alopecia: Case Reports and Trichoscopic Findings

research Syphilitic Alopecia: Case Reports and Trichoscopic Findings

29 citations , January 2017 in “Skin appendage disorders”

This case study highlights the importance of considering syphilis in the differential diagnosis for hair loss, as patients with the infection may present with non-typical alopecia patterns.

Syphilitic Alopecia: A Report of 5 Cases and a Review of the Literature

research Syphilitic Alopecia: A Report of 5 Cases and a Review of the Literature

13 citations , June 2013 in “Actas Dermo-Sifiliográficas”

This review details five cases of syphilitic alopecia, an uncommon symptom in syphilis affecting mainly men, emphasizing that dermatologists should be vigilant as it can appear as the sole symptom.

Alopecia Areata: Clinical Presentation, Diagnosis, and Unusual Cases

research Alopecia Areata: Clinical Presentation, Diagnosis, and Unusual Cases

109 citations , May 2011 in “Dermatologic Therapy”

This article reviews the characteristics, associations, and diagnostic criteria for alopecia areata and reports no new clinical findings; the authors note the disease's unpredictable course and variable prognosis.