What Is Your Diagnosis? Alopecia Due to Syphilis

A 5-year-old male patient presented with patchy alopecia in the parietooccipital region, adenomegaly, and a history of maculopapular rash. Laboratory tests ruled out several infections, but the VDRL test was positive, indicating syphilis. The patient received treatment with penicillin G benzathine and showed favorable progress, with negative VDRL controls post-treatment. Syphilitic alopecia, a rare manifestation of secondary syphilis, can present in three patterns: moth-eaten, diffuse, and mixed. The moth-eaten pattern, observed in this case, is characterized by small, non-scarring alopecic patches. Differential diagnoses include alopecia areata, systemic lupus erythematosus, hypothyroidism, and COVID-19-associated alopecia. Treatment of syphilitic alopecia involves addressing the underlying syphilis infection, typically resolving within 3 months post-antibiotic therapy.