Syphilis Presenting as Hair Loss

The document discusses two cases where syphilis presented as hair loss, which is an unusual manifestation of the disease. In the first case, a 24-year-old woman experienced progressive hair loss over three months without a rash but had unprotected sexual intercourse with a stranger eight weeks prior to the hair loss. Her Venereal Diseases Research Laboratory (VDRL) test was positive, and after treatment with procaine penicillin, her hair began to regrow, and telogen counts returned to normal. The second case involved a 25-year-old homosexual man with thinning scalp hair for four months, who previously had a rash and was found to have positive syphilis serology, including in the cerebrospinal fluid. He also responded to treatment with procaine penicillin with hair regrowth. The discussion emphasizes that syphilis should be considered in patients with non-scarring alopecia that cannot be readily explained, as both patients had their alopecia reversed by treating the syphilis, despite the absence of typical syphilitic symptoms or histological changes in the hair loss.