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Alopecia Areata in a Patient Undergoing Treatment for Secondary Syphilis: A Diagnostic Challenge

Year: 2026

Type: article

Abstract: A 17-year-old male with a recent history of incarceration and a diagnosis of secondary syphilis presented for follow-up three months after receiving appropriate antibiotic treatment. His venereal disease research laboratory (VDRL) titers showed a favorable decline (from 1:16 to 1:4); however, he reported new-onset patchy scalp alopecia. Clinically, the lesions raised suspicion for syphilitic alopecia (SA). Nevertheless, trichoscopy revealed hallmark findings of alopecia areata (AA), including exclamation mark hairs and black dots, while lacking specific signs of SA, such as an erythematous background. HIV screening was negative. The patient showed significant hair regrowth after six weeks of topical clobetasol. This case highlights that AA can clinically mimic SA, even in patients with active or recent syphilis, and underscores the value of trichoscopy in preventing misdiagnosis and avoiding anchoring bias.

Source: Cureus

DOI: 10.7759/cureus.103005

Authors: Diego I Mendez-Villanueva, Ana Martinez, Diana Castro, Nicolas Opazo, Diego Guarda

Institutions: Universidad de Santiago de Chile, Universidad Andrés Bello

Language: English

Topic: Hair Growth and Disorders

Subfield: Urology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7127915209