Syphilitic alopecia: uncommon trichoscopic findings

Syphilitic alopecia: uncommon trichoscopic findings


  • Linda Tognetti Department of Dermatology, Division of Medical, Surgical and Neuro-Sciences, University of Siena, Siena (Italy)Department of Medical Biotechnologies, University of Siena, Siena (Italy)
  • Elisa Cinotti Dermatology Unit - Department of Medical, Surgical and Neuro Sciences - University of Siena, Siena (Italy)
  • Jean-Luc Perrot Service de Dermatologie, Hôpital Universitaire de Saint-Etienne, 42055 Saint Etienne Cedex 2, (France)
  • Marco Campoli
  • Pietro Rubegni


secondary syphilis, moth-eaten and diffuse syphilitic alopecia, trichoscopy


Syphilitic alopecia (SA) is considered an uncommon manifestation of secondary syphilis. SA can present in a diffuse form, resembling telogen effluvium, or in a moth-eaten form that mimics a variety of conditions (i.e., alopecia areata, trichotillomania, lichen planus pilaris or tinea capitis). When the two forms coexist, we observe a mixed pattern. Essential SA manifests without evidence of mucocutaneous syphilis manifestations and its diagnosis is often delayed. To date, trichoscopic description of SA forms are based on very few cases (i.e., five patients with moth-eaten SA and one with diffuse SA). This is the first report of a mixed pattern of essential SA: some new trichoscopic features—such as tapered bended hairs, erythematous background, diffuse scaling and perifollicular hyperkeratosis—are described in a 32-year-old man. In the absence of secondary syphilis manifestations, dermoscopy can be a useful tool that helps suspect and differentiate SA from its common mimickers.


Vafaie J, Weinberg JM, Smith B, Mizuguchi RS. Alopecia in association with sexually transmitted disease: a review. Cutis. 2005;76:361-366. PubMed

Hernandez-Bel P, Unamuno B, Sanchez-Carazo JL, et al. Syphilitic alopecia: a report of 5 cases and a review of the literature. Actas Dermosifiliogr. 2013;104:512-517. PubMed CrossRef

Bi MY, Cohen PR, Robinson FW, Gray JM. Alopecia syphilitica—report of a patient with secondary syphilis presenting as moth-eaten alopecia and a review of its common mimickers. Dermatol Online J. 2009;15:6. PubMed

Ye Y, Zhang X, Zhao Y, et al. The clinical and trichoscopic features of syphilitic alopecia. J Dermatol Case Rep. 2014;3:78-80. PubMed CrossRef

Piraccini BM, Broccoli A, Starace M, et al. Hair and scalp manifestations in secondary. syphilis: epidemiology, clinical features and trichoscopy. Dermatology. 2015;231(2):171-176. PubMed CrossRef

Jordaan HF, Louw M. The moth-eaten alopecia of secondary syphilis. A histopathological study of 12 patients. Am J Dermatopathol. 1995;17:158. PubMed

Lee JY, Hsu ML. Alopecia syphilitica, a simulator of alopecia areata: histopathology and differential diagnosis. J Cutan Pathol. 1991;10:87. PubMed

Nam-Cha Sh. Alopecia syphilitica with detection of Treponema Pallidum in the hair follicle. J Cutan Pathol. 2007;34(1):37-40. PubMed CrossRef

Miteva M, Tosti A. Hair and scalp dermatoscopy. J Am Acad Dermatol. 2012;67(5):1040-1048. PubMed CrossRef

Inui S, Nakajima T, Nakagawa K, Itami S. Clinical significance of dermoscopy in alopecia areata: Analysis of 300 cases. Int J Dermatol. 2008;47:688-693. PubMed CrossRef







How to Cite

Syphilitic alopecia: uncommon trichoscopic findings. Dermatol Pract Concept [Internet]. 2017 Aug. 2 [cited 2024 Apr. 13];7(3). Available from: