Last Updated: 2023-10-12
Author(s): Navarini A.A.
Alopecia syphilitica was first described by Hutchinson in the 19th century.
Syphilitic hair loss
Alopecia syphilitica is a form of hair loss that occurs as a result of secondary infection with syphilis and is characterised by irregular, moth-eaten hair loss.
Age peak: Alopecia syphilitica affects adults who have syphilis, with no age preference.
Gender: Both sexes are equally affected
Geography and ethnicity: The disease occurs worldwide and shows no ethnic preference.
There is no specific classification for alopecia syphilitica. It is a manifestation of secondary syphilis.
The aetiology of alopecia syphilitica is due to infection with Treponema pallidum, the causative agent of syphilis.
Alopecia syphilitica presents as irregular, moth-eaten hair loss that may occur diffusely or in multiple, clearly circumscribed, hairless areas.
The diagnosis of alopecia syphilitica is based on clinical findings, history of syphilis infection and serological tests to detect Treponema pallidum.
Alopecia syphilitica predominantly affects the scalp.
Risk factors for alopecia syphilitica are unprotected sexual intercourse, previous syphilis infection and comorbidities such as HIV.
Histopathological findings in alopecia syphilitica are non-specific and may show perifollicular inflammation, hyperkeratosis, papillomatosis and epidermal atrophy. The Treponema pallidum pathogens can be detected in the tissues with immunohistochemical staining.
Untreated, alopecia syphilitica can lead to permanent hair loss.
With adequate antibiotic therapy, the prognosis of alopecia syphilitica is good and hair loss is usually reversible. Without therapy, however, hair loss can be permanent.
Prophylaxis for alopecia syphilitica consists of prevention of syphilis infection through safer sex practices and education about the risks of infection.
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