Moth-Eaten Essential Syphilitic Alopecia in Human Immunodeficiency Virus-Positive Patient: A Case Report

Satiti Pudjiati

doi:10.31579/2690-4861/111

Abstract

Hair loss is rare to be reported as sole manifestation of secondary syphilis. Syphilitic alopecia consists of symptomatic syphilitic alopecia that presents with other secondary syphilis manifestation, and essential syphilitic alopecia which can be patchy ("moth-eaten" type), diffuse, or combination without other manifestations of secondary syphilis. Here we report a case of secondary syphilis in patient with Human Immunodeficiency Virus (HIV) that present with moth-eaten alopecia as a sole manifestation. A 35-year-old male with HIV complained hair loss on his scalp and eyebrows. Physical examination showed non scarring moth-eaten alopecia on his scalp and lossof lateral third of his eyebrows without other lesions. Serological test for syphilis was positive. He was treated with 2.4 millions unit of benzathine penicillin G (BPG), single dose intramuscular injection. Six months after injection, patient showed clinical and serological improvement. Syphilitic alopecia cannot be ruled out in patients with non scarring hair loss with unclear etiology. Serological tests are recommended especially for patients with history of high risk sexual behaviour.

Highlights

Hair loss is rare to be reported as sole manifestation of secondary syphilis
Syphilitic alopecia consists of symptomatic syphilitic alopecia that presents with other secondary syphilis manifestation, and essential syphilitic alopecia which can be patchy ("moth-eaten" type), diffuse, or combination without other manifestations of secondary syphilis
We report a case of secondary syphilis in patient with Human Immunodeficiency Virus (HIV) that present with moth-eaten alopecia as a sole manifestation

Summary

Introduction

Syphilitic alopecia (SA) is a rare cutaneous manifestation of secondary syphilis, ranging from 2.9 to 7% of all cases. Motheaten SA is the most commonly found and it presents as patchy alopecia in varying size, indistinct borders resembling the hair was eaten by moth. It mainly occurs in the parieto-occipital area [3, 4]. In 1940, Mc Carthy divided SA into 2 types including symptomatic syphilitic alopecia and essential SA with alopecia as the only presenting symptom [1, 2] Motheaten alopecia accounted for 2.9 to 48% of all reported cases of secondary syphilis and very rarely reported as a sole manifestation of secondary syphilis. Delay in diagnosis can increase the risk of syphilis progression to tertiary stage and resulting mortality [5, 6]

Case Presentation

Findings

Discussion