Alopecia as the initial presentation of secondary syphilis: A case report and review of literature

Syphilitic alopecia is a rare cutaneous manifestation of secondary syphilis. It is described as a non-scarring hair loss which usually presents as the pathognomonic moth-eaten pattern. Syphilis-associated alopecia often mimics that of other types of hair loss, which may lead to misdiagnosis or delay in treatment. Herein, we present a case of a 29-year-old man who presented with hair loss and pruritic painless scalp lesions. His history was unremarkable except for another sexually transmitted infection two years ago, along with sexual contact two months prior to his current presentation. Diagnosis of secondary syphilis was confirmed through serological tests. Hair regrowth was achieved within approximately three months following penicillin treatment. The present case highlights the strong clinical acumen required to diagnose secondary syphilis in a patient presenting with alopecia, particularly when it is the only initial presenting symptom.