Diffuse Syphilitic Alopecia

May 2015 in “ Infection ”

Alexander Zink, K. Kaliebe, Christoph D. Spinner

alopecia syphilitica secondary syphilis alopecia areata non-inflammatory hair loss non-scarring hair loss diffuse hair loss moth-eaten pattern benzylpenicillin prednisolone syphilitic alopecia penicillin steroid

TLDR Treatment with benzylpenicillin and prednisolone cured the patient's syphilis and hair loss.

A patient presented with large ulceration on the hard palatine mucosa and cervical lymphadenopathy, and was diagnosed with secondary syphilis with alopecia syphilitica diffusa, lymphadenopathy, and a persisting hard chancre. Laboratory tests confirmed the diagnosis with a reactive TPPA and a VDRL test of 1:256. Treatment with a single intramuscular injection of benzylpenicillin and prednisolone prophylaxis led to complete resolution of symptoms. Alopecia syphilitica, a rare manifestation of secondary syphilis affecting about 5% of patients, can mimic alopecia areata and is characterized by non-inflammatory, non-scarring hair loss in a diffuse or moth-eaten pattern.

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