Abstract
This paper presents a case of Moth-Eaten Alopecia as the only clinical manifestation of secondary syphilis in a 28-year-old man from Nepal. The patient exhibited progressive hair loss in the occipitoparietal region without associated pain or itching. With a positive Rapid Plasma Reagin (RPR) test (1:256), the patient received a three-week course of Benzathine Penicillin G, resulting in complete hair regrowth within four months. This case underscores the significance of recognizing moth eaten alopecia as a potential dermatological sign of secondary syphilis, especially when it appears as the sole clinical symptom.
Keywords: moth eaten alopecia, alopecia syphilitica, secondary syphilis, Nepal
A 28-year-old man visited the dermatology clinic due to a two-year history of hair loss in the occipitoparietal region of his scalp. Initially, the hair loss was minimal, observed during bathing and on the pillow in the morning, but it progressively worsened, causing significant cosmetic concern (see Fig. 1). There was no pain or itching associated with the hair loss, and no eyebrows, facial hair, axillary, or pubic hair was affected. Upon examination, irregular patches of hair loss without scarring, scales, or inflammation were observed. The patient had a history of multiple sexual partners, including sex workers, but denied intravenous drug use or blood transfusions.
Figure 1.
Moth Eaten Alopecia in 28-year-old male.
Serological tests revealed a positive Rapid Plasma Reagin (RPR) with titers of 1:256. Complete blood count, renal and liver function tests, and serologies for HIV, Hepatitis B, and Hepatitis C were normal. Treatment involved weekly injections of 2.4 million units of Benzathine Penicillin G for three weeks. Hair growth began post-treatment, with complete regrowth achieved after four months.
The diagnosed condition was moth-eaten alopecia, found in 3%–7% of secondary syphilis patients [1]. This pattern, patchy or diffuse, typically occurs in the occipital and parietal regions and is a pathognomonic manifestation of secondary syphilis [1–3]. It may be accompanied by nonpruritic erythema, a history of genital chancre, or painless generalized lymphadenopathy and can affect hairy skin other than the scalp [1]. In symptomatic moth-eaten alopecia, it is associated with other mucocutaneous signs of secondary syphilis, while in essential cases, alopecia is the sole clinical sign [2]. Differential diagnoses of this ‘great mimicker’ include alopecia areata, tinea capitis, and trichotillomania. Syphilitic alopecia, resembling alopecia areata clinically and histopathologically [1, 2], is differentiated by the presence of ‘exclamation point’ hairs in the latter. Fungal testing distinguishes it from tinea capitis, and trichoscopy findings and history differentiate it from trichotillomania [1, 2]. Resolution typically occurs 3 months after antibiotic administration [3].
ACKNOWLEDGEMENTS
We express our gratitude to our professors, family, and friends for their invaluable assistance in shaping this case report. Special thanks to the patient for their cooperation.
Contributor Information
Amrita Shrestha, Koshi Hospital, Biratnagar, Koshi Province, Nepal.
K C Kusha, Epidemiology and Disease Control Division, Nepal.
Abal Baral, Ministry of Health and Population, Nepal.
CONFLICT OF INTEREST STATEMENT
No conflicts of interest.
FUNDING
None.
ETHICAL APPROVAL
Not needed for case reports in our institution.
CONSENT
Written informed consent was obtained from the patient for publication and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.
GUARANTOR
Abal Baral.
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