September 2025, Volume 3, Issue 9

Author

Neerja Saraswat, Shekhar Neema, Durga Madhab Tripathy, Eeshaan Ranjan and Sushil Kumar

Abstract

Syphilitic alopecia (SA) is an uncommon manifestation of secondary syphilis which mimics common non-cicatricial alopecias. Dermoscopy/trichoscopy has been increasingly used as a non-invasive tool for the diagnosis of hair disorders. In some cases, specific dermoscopic features instantaneously clinch the diagnosis while in most other cases including syphilitic alopecia the findings are supportive. We report two cases of syphilitic alopecia with characteristic dermoscopic findings. Dermoscopy of both the patients showed alopecic patches with empty hair follicles, vellus hairs, hypopigmented to depigmented hairs and telangiectasias in a diffuse erythematous background. The absence of exclamation mark hairs as seen in alopecia areata, cork-screw hairs in tinea capitis, and lack of trichoptilosis, flame hairs and tulip hairs in trichotillomania makes the diagnosis of SA more likely. The case series highlights some valuable dermoscopic features of SA, a sparsely researched entity. Since syphilis, the great mimicker, has resurged, SA is gradually turning into a major mimicker in dermoscopy as well. Meticulous use of this non-invasive tool will help efface common hair disorders that simulate SA for prompt diagnosis and favourable therapeutic outcomes.