obsolete syphilitic alopecia

Moth-eaten Alopecia Syphilitica: A Rare Manifestation of Secondary Syphilis

Moth-eaten alopecia syphilitica is a rare and unusual manifestation of secondary syphilis, characterized by a distinctive pattern of hair loss on the scalp. This condition is often associated with other symptoms of secondary syphilis, such as skin lesions and mucocutaneous findings.

Clinical Presentation

The clinical presentation of moth-eaten alopecia syphilitica typically involves a diffuse or patchy thinning of hair on the scalp, with some areas showing a more pronounced "moth-eaten" appearance [1]. The affected areas may also exhibit empty ostia, dilated capillaries, an erythematous background, and decreased hair density [2].

Dermoscopic Features

Dermoscopy is a useful tool for diagnosing moth-eaten alopecia syphilitica. The dermoscopic examination of the affected area may reveal empty hair follicles, vellus hair, follicular hyperkeratosis, peripheral black dots, dilated and tortuous vessels, and decreased hair density [3].

Prevalence

Moth-eaten alopecia syphilitica is a relatively rare manifestation of secondary syphilis, with a prevalence ranging from 3% to 7% [4]. Due to its low prevalence and similar presentation to other forms of alopecia, it can be challenging to diagnose.

References:

[1] CMAJ, Qiao J and Fang H (reprinted with permission) - "Moth-eaten alopecia syphilitica" [2] A 33-year-old male patient presenting with moth-eaten alopecia syphilitica [5] [3] Dermoscopic features of moth-eaten alopecia syphilitica [6] [4] Prevalence of moth-eaten alopecia syphilitica in patients with secondary syphilis [7] [5] C Sibbald, "Alopecia areata: an immune-mediated condition leading to non-scarring alopecia" [8]

Note: The references provided are based on the search results and may not be exhaustive or up-to-date.

Obsolete Syphilitic Alopecia: A Rare Condition

Obsolete syphilitic alopecia, also known as syphilis-induced hair loss, is a rare condition that occurs in the late stages of syphilis infection. This condition is characterized by patchy or diffuse hair loss on the scalp.

Common Symptoms:

• Patchy or diffuse hair loss on the scalp [1]
• Hair loss may be accompanied by other symptoms such as skin lesions, fever, and fatigue [2]
• In some cases, hair loss may be preceded by a rash or other skin manifestations [3]

Less Common Symptoms:

• Scalp tenderness or itching [4]
• Hair thinning or brittleness [5]
• In rare cases, hair loss may be accompanied by neurological symptoms such as numbness or tingling in the scalp [6]

Causes and Risk Factors:

• Late-stage syphilis infection is the primary cause of obsolete syphilitic alopecia [7]
• Individuals with a weakened immune system may be more susceptible to this condition [8]
• Other risk factors include poor nutrition, stress, and certain medical conditions such as thyroid disorders or autoimmune diseases [9]

Diagnosis:

• Diagnosis of obsolete syphilitic alopecia is typically made through a combination of clinical evaluation, laboratory tests (such as blood tests for syphilis), and scalp biopsy [10]
• A dermatologist or infectious disease specialist may be involved in the diagnosis and treatment of this condition [11]

Treatment:

• Treatment of obsolete syphilitic alopecia involves addressing the underlying syphilis infection with antibiotics such as penicillin [12]
• In some cases, additional treatments such as corticosteroids or immunomodulators may be necessary to manage symptoms and promote hair growth [13]

References:

[1] - Context: Search result 3 mentions "patchy or diffuse hair loss on the scalp" as a symptom of obsolete syphilitic alopecia.

[2] - Context: Search result 5 lists "skin lesions, fever, and fatigue" as symptoms that may accompany hair loss in this condition.

[3] - Context: Search result 1 mentions that hair loss may be preceded by a rash or other skin manifestations.

[4] - Context: Search result 2 notes that scalp tenderness or itching may occur in some cases of obsolete syphilitic alopecia.

[5] - Context: Search result 6 reports that hair thinning or brittleness may also occur in this condition.

[6] - Context: Search result 4 mentions that neurological symptoms such as numbness or tingling in the scalp may occur in rare cases.

[7] - Context: Search result 1 states that late-stage syphilis infection is the primary cause of obsolete syphilitic alopecia.

[8] - Context: Search result 3 notes that individuals with a weakened immune system may be more susceptible to this condition.

[9] - Context: Search result 5 lists poor nutrition, stress, and certain medical conditions as risk factors for obsolete syphilitic alopecia.

[10] - Context: Search result 2 describes the diagnostic process for obsolete syphilitic alopecia, which involves a combination of clinical evaluation, laboratory tests, and scalp biopsy.

[11] - Context: Search result 1 notes that a dermatologist or infectious disease specialist may be involved in the diagnosis and treatment of this condition.

[12] - Context: Search result 3 states that treatment of obsolete syphilitic alopecia involves addressing the underlying syphilis infection with antibiotics such as penicillin.

[13] - Context: Search result 5 mentions that additional treatments such as corticosteroids or immunomodulators may be necessary to manage symptoms and promote hair growth.

Treatment Options for Obsolete Syphilitic Alopecia

Syphilitic alopecia, also known as syphilis-related hair loss, is a rare condition that occurs in some individuals with syphilis. While it's considered an obsolete treatment, benzathine penicillin G was once the primary medication used to treat this condition.

• Benzathine Penicillin G: This antibiotic was commonly administered to patients with syphilitic alopecia as a single dose of 2.4 million units (MU) [9]. However, failures have been reported in case reports and small series, mainly in cases where the disease had progressed to its tertiary stage [9].
• Other Treatments: In some cases, topical and oral corticosteroids, minoxidil, and anthralin were used as alternative treatments

Differential Diagnosis of Syphilitic Alopecia

Syphilitic alopecia, also known as alopecia syphilitica, is a rare manifestation of secondary syphilis characterized by non-scarring hair loss. When diagnosing this condition, it's essential to consider other differential diagnoses that may mimic its symptoms.

List of Differential Diagnoses:

• Alopecia Areata: This autoimmune disease causes patchy hair loss and is often considered the main differential diagnosis for syphilitic alopecia.
• Lupus: Systemic lupus erythematosus (SLE) can cause hair loss, among other symptoms, making it a potential differential diagnosis.
• Trichotillomania: This psychological disorder involves compulsive hair-pulling and can lead to patchy hair loss similar to syphilitic alopecia.
• Tinea Capitis: A fungal infection of the scalp that can cause hair loss and is often considered in the differential diagnosis for syphilitic alopecia.
• Lichen Planus Pilaris: An inflammatory skin condition that can cause hair loss, making it a potential differential diagnosis.
• Telogen Effluvium: A condition characterized by excessive hair shedding due to hormonal changes or stress.

Key Diagnostic Features:

To differentiate syphilitic alopecia from other conditions, dermatologists look for specific clinical features, including:

• Empty ostia with yellow and black coloration
• Dilated capillaries
• Erythematous background
• Decreased hair density

These characteristics can help distinguish syphilitic alopecia from other differential diagnoses.

References:

• [6] Syphilitic alopecia is a relatively uncommon manifestation of syphilis, and its diagnosis requires consideration of other differential diagnoses.
• [7] A lack of exclamation hair, comma hair, flame hairs, or “v” sign can exclude the diagnosis of syphilitic alopecia in favor of other conditions.
• [12] SA has several differential diagnoses, including alopecia areata (the main differential diagnosis), lupus, trichotillomania, tinea capitis, lichen planus pilaris, and telogen effluvium.