Secondary Syphilis

Any adult with patchy hair loss with preservation of follicular openings should be questioned about sexual exposures. This presentation is not typical of alopecia areata, and the patient is too old for tinea capitis to be a major consideration.

A 29-year-old man complained about recent severe hair loss. He otherwise felt well.

Key point: This patient demonstrates “patchy” hair loss with preservation of follicular openings. The areas of hair loss are not totally smooth, which would be typical of alopecia areata. He is too old for tinea capitis to be the major consideration. Any adult patient with this presentation should be questioned about sexual exposures, and a serologic test for syphilis should be performed. His RPR was positive in a titer of 1:256. His diagnosis is secondary syphilis.

Treatment: The patient was treated with intramuscular benzathine penicillin (2.4 million units). Complete hair re-growth was evident in about 6 months.

Note: He must be reported to the county health department to facilitate contact tracing.