Nonspecific Diffuse Alopecia as a Single Manifestation of Syphilis Infection: Clinical and Trichoscopic Features

In the 2018 case report, two patients with secondary syphilis presented with nonspecific diffuse alopecia as the sole symptom, a rare occurrence since hair loss in syphilis typically accompanies other mucocutaneous manifestations. The first case involved a 14-year-old female with hair loss in the parieto-occipital area and eyebrow rarefaction, while the second case was a 23-year-old male with diffuse hair loss. Both cases lacked the "moth-eaten" pattern commonly associated with syphilis and showed no other signs of infection. Trichoscopy revealed decreased hair density without signs of inflammation, and both patients had positive serological tests for syphilis. After treatment with benzathine penicillin, complete hair regrowth was observed. The report emphasizes the importance of considering syphilis in the differential diagnosis of sudden, unexplained alopecia, especially in sexually active patients, to ensure timely treatment and prevent misdiagnosis and complications.