A patient with syphilis may present with alopecia.
Clinical patterns of syphilitic alopecia:
(1) patchy, "moth-eaten"
(2) generalized, diffuse thinning
(3) mixed (patchy and diffuse)
Other manifestations of syphilis may or may not be present. The presence of hair loss and absence of other manifestations is termed "essential syphilitic alopecia".
Histologic patterns:
(1) dense, lichenoid and deep perivascular infiltrate with plasma cells
(2) telogen effluvium like (noninflammatory)
(3) alopecia areata like (peribulbar lymphocytic or mononuclear cell infiltrate with none or few plasma cells)
A patient with unexplained, rapid hair loss or sudden worsening of existing alopecia should be evaluated for syphilis, which may include serologic testing for syphilis.
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