Unusual Diffuse Hair Loss

Abstract

CASE REPORT A 35-year-old Taiwanese man reported gradual diffuse hair loss on his scalp and bilateral eyebrows for 2 months. He had had chronic urticaria for more than 4 years. He denied taking new medications or having been ill during the preceding 6 months. He denied having unprotected sex or having been exposed him to any blood or serum products. Two months prior to the manifestation of hair loss, he had a transient generalized maculopapular eruption which occurred 1 day after receiving an infl uenza vaccination. There was no family history of androgenetic alopecia. A physical examination revealed diffuse thinning of the hair with decreased hair density of the scalp, especially over the vertex region (Fig. 1). A hair pull test showed that one to two telogen hairs were pulled out each time. The initial clinical differential diagnoses included androgenetic alopecia, telogen effl uvium, and the diffuse type of alopecia areata. Blood tests for a complete blood cell count and an antinuclear antibody were within normal limits. A 5% minoxidil solution was prescribed, but diffuse thinning of the hair with decreased hair density seemed to have progressed at the 1-month follow-up. Therefore, further examinations were performed. Serologic tests for syphilis demonstrated a rapid plasma regain (RPR) titer of 1: 32x. The Treponema pallidum hemagglutination assay was also positive (1: 5120x). Meanwhile, due to a palpable enlarged thyroid gland during the physical examination, a thyroid function test was performed but results were normal. The remainder of the skin and mucous membrane examination was normal. The patient was treated with an intramuscular injection of 2.4 x 10 units of benzathine benzylpenicillin once a week for three times. In 2 months, there was dramatic hair re-growth (Fig. 2A, B) and a gradual decline in the RPR titer (1: 16x). Resident Forum