Moth-Eaten Alopecia as the Only Manifestation of Syphilis: A Case from Nepal

This case report describes a 28-year-old man from Nepal who presented with moth-eaten alopecia as the sole manifestation of secondary syphilis. The patient experienced progressive hair loss in the occipitoparietal region without pain or itching. A positive Rapid Plasma Reagin (RPR) test confirmed the syphilis diagnosis, and treatment with Benzathine Penicillin G led to complete hair regrowth within four months. The report highlights the importance of recognizing moth-eaten alopecia as a potential indicator of secondary syphilis, especially when it is the only clinical symptom. Differential diagnoses include alopecia areata, tinea capitis, and trichotillomania, but syphilitic alopecia is distinguished by its specific clinical and histopathological features.