Rapidly Progressive Hair Loss May Be the Only Sign of Syphilis

Published:February 21, 2022DOI:
      A previously healthy 20-year-old woman was referred to our dermatology clinic with a 1-month history of progressive cranial hair loss. She had been treated with topical steroids but with little effect. Clinical examination found diffuse nonscarring hair loss in the frontal, parietal, and temporal regions, with no erythematous background (Figure A). In addition, a trichoscopic examination revealed a small number of yellow dots and villus hairs. Exclamation mark hairs were not observed. There were no other skin, mucosal, or nail symptoms. She had no superficial lymphadenopathy. Laboratory investigations revealed an elevated titer of rapid plasma reagin (1:64), positive Treponema pallidum hemagglutination assay test, and reactive fluorescent treponemal antibody absorption test. Syphilitic alopecia was diagnosed. The results of serologic tests for liver function and HIV were unremarkable. Treatment with oral amoxicillin at 1500 mg/d was initiated; the titer of rapid plasma reagin had decreased to 1:16 at 8 weeks later, and her hair growth had returned to normal at 12 weeks later (Figure B).
      Figure(A) Diffuse nonscarring hair loss in the frontal and parietal regions. (B) Hair regrowth at 12 weeks of treatment with oral amoxicillin.
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