title: Hair and Scalp Manifestations in Secondary Syphilis: Epidemiology, Clinical Features and Trichoscopy.
abstract: BACKGROUND
  Syphilitic alopecia (SA) is mainly described in single case reports, and there are only a few epidemiological studies.
  
  
  OBJECTIVE
  To investigate the clinical and dermoscopic features of SA in patients with secondary syphilis and to record its actual prevalence.
  
  
  METHODS
  All patients with a diagnosis of secondary syphilis were clinically and trichoscopically evaluated in search of hair and scalp alterations.
  
  
  RESULTS
  Five of 12 patients (41.6%) diagnosed with secondary syphilis had SA. The 'moth-eaten' pattern was detected in 4 patients (80% of cases): 1 had 'essential' SA, whereas 3 patients had 'symptomatic' SA. The 'diffuse' SA pattern was found in 1 patient. Trichoscopy of the 'moth-eaten' areas showed that alopecia is mainly due to a reduction in the number of terminal hairs. One patient with secondary syphilis showed trichodynia that regressed completely after antibiotic therapy.
  
  
  CONCLUSIONS
  The small number of patients included and the fact that none of our patients accepted to be biopsied in an affected area.
  
  
  CONCLUSIONS
  Since SA appears to be present much more frequently than reported in the literature, when secondary syphilis is suspected, the patient should be examined for the presence of signs compatible with SA and the scalp should be examined by dermoscopy.
authors.affiliation: Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
authors.forename: Bianca Maria
authors.initials: BM
authors.lastname: Piraccini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Broccoli
authors.forename: Michela
authors.initials: M
authors.lastname: Starace
authors.forename: Valeria
authors.initials: V
authors.lastname: Gaspari
authors.forename: Antonietta
authors.initials: A
authors.lastname: D'Antuono
authors.forename: Emi
authors.initials: E
authors.lastname: Dika
authors.forename: Annalisa
authors.initials: A
authors.lastname: Patrizi
mesh_terms: D000328:Adult; D000505:Alopecia / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D046169:Dermoscopy; D005148:Facial Dermatoses / Q000382:microbiology / Q000473:pathology*; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012536:Scalp Dermatoses / Q000382:microbiology / Q000473:pathology*; D013587:Syphilis / Q000150:complications*