Differential diagnostics of syphilitic alopecia and alopecia areata: The clinical picture and trichoscopic signs

Abstract

This paper describes a clinical case of secondary syphilis, which was manifested exclusively by syphilitic alopecia.We describe the details of the clinical picture, as well as a differential diagnosis of syphilitic alopecia and alopecia areata on the basis of trichoscopy data.For a patient with scalp lesions typical of syphilis (focal form of alopecia), the trichoscopic picture was represented by hairs broken at different heights from 1 to 5 mm, “empty” follicles (“yellow” dots), anisotrichosis due to the loss of terminal hair. The eyebrow trichoscopy showed “yellow dots”, vellus hairs, hair thinning due to the loss of bristly hair. A comparison of the trichoscopic pictures for alopecia areata and syphilitic areata have revealed the absence in the latter of a number of signs typical of the former, such as pencil-point, ex clamation-point, zigzag, monilethrix and tulip hairs.Patients with a clinical picture of focal, diffuse or mix ed alopecia should be tested for syphilis using serological methods.