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Differential diagnostics of syphilitic alopecia and alopecia areata: The clinical picture and trichoscopic signs
- Authors: Mareeva A.N.1, Katunin G.L.1, Rubtsov A.B.1
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Affiliations:
- State Research Center of Dermatovenereology and Cosmetology, Ministr y of Health of the Russian Federation
- Issue: Vol 95, No 3 (2019)
- Pages: 34-39
- Section: CLINICAL PRACTICE GUIDELINES
- Submitted: 02.10.2019
- Accepted: 02.10.2019
- Published: 02.06.2019
- URL: https://vestnikdv.ru/jour/article/view/496
- DOI: https://doi.org/10.25208/0042-4609-2019-95-3-34-39
- ID: 496
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Abstract
This paper describes a clinical case of secondary syphilis, which was manifested exclusively by syphilitic alopecia.
We describe the details of the clinical picture, as well as a differential diagnosis of syphilitic alopecia and alopecia areata on the basis of trichoscopy data.
For a patient with scalp lesions typical of syphilis (focal form of alopecia), the trichoscopic picture was represented by hairs broken at different heights from 1 to 5 mm, “empty” follicles (“yellow” dots), anisotrichosis due to the loss of terminal hair. The eyebrow trichoscopy showed “yellow dots”, vellus hairs, hair thinning due to the loss of bristly hair. A comparison of the trichoscopic pictures for alopecia areata and syphilitic areata have revealed the absence in the latter of a number of signs typical of the former, such as pencil-point, ex clamation-point, zigzag, monilethrix and tulip hairs.
Patients with a clinical picture of focal, diffuse or mix ed alopecia should be tested for syphilis using serological methods.
Keywords
About the authors
A. N. Mareeva
State Research Center of Dermatovenereology and Cosmetology, Ministr y of Health of the Russian Federation
Author for correspondence.
Email: nastasya_66@mail.ru
Anastasia N. Mareeva* — Cand. Sci. (Med.), Dermatovenerologist, Consultative Diagnostic Centre
tel.: +7 (903) 586-27-79
РоссияG. L. Katunin
State Research Center of Dermatovenereology and Cosmetology, Ministr y of Health of the Russian Federation
Email: fake@neicon.ru
Georgy L. Katunin — Cand. Sci. (Med.), Dermatovenerologist, Department of Sexually Transmitted Infections Россия
A. B. Rubtsov
State Research Center of Dermatovenereology and Cosmetology, Ministr y of Health of the Russian Federation
Email: fake@neicon.ru
Anton B. Rubtsov — Research Assistant, Department of Sexually Transmitted Infections Россия
References
- Pratt C. H., King L. E., Messenger A. G., Christiano A. M., Sundberg J. P. Alopecia areata. Nat Rev Dis Prim. 2017;3:17011.
- Gilhar A., Paus R., Kalish R. Lymphocytes, neuropeptides, and genes involved in alopecia areata. J Clin Invest. 2007 Aug 1;117(8):2019–2027.
- Price V. Therapy of alopecia areata: on the cusp and in the future. J Invest Dermatol Symp Proc. 2003;8:207–211.
- Федеральные клинические рекомендации. Дерматовенерология 2015: Болезни кожи. Инфекции, передаваемые половым путем. 5-е изд., перераб. и доп. М.: Деловой экспресс, 2016. С. 679–720. [Federal clinical recommendations. Dermatovenerology 2015: Diseases of the skin. Sexually transmitted infections. 5th ed., rev. and add. Moscow: Delovoy ekspress, 2016. P. 679 –720. (In Russ.)]
- Кубанова А. А., Мелехина Л. Е., Кубанов А. А. Основные задачи развития дерматовенерологической помощи населению Российской Федерации на период до 2024 года. Результаты деятельности медицинских организаций по оказанию дерматовенерологической помощи населению Российской Федерации в 2017 году. Вестник дерматологии и венерологии. 2018;94(5):9–25. [Kubanova A. A., Melexina L. E., Kubanov A. A. Key objectives of dermatovenerological assistance to the Russian Federation population for the period up to 2024. Results of the activities of medical organizations in providing dermatovenerological assistance to the Russian Federation population in 2017. Vestnik dermatologii i venerologii. 2018;94(5):9–25. (In Russ.)]
- Vafaie J., Weinberg J. M, Smith B. et al. Alopecia in association with sexually transmitted disease: a review. Cutis. 2005;76:3.
- Ornelas J., Agbai O. N, Kiuru M., Sivamani R. K. Alopecia as the Presenting Symptom of Syphilis. Dermatol Online J. 2015 Jul 15;21(7). PII: 13030/qt7q58360j
- Piraccini B. M., Broccoli A., Starace M. et al. Hair and scalp manifestations in secondary syphilis: epidemiology, clinical features and trichoscopy. Dermatology. 2015;231:171–176.
- Hernández-Bel P., Unamuno B., Sánchez-Carazo J. L., Febrer I., Alegre V. Syphilitic alopecia: a report of 5 cases and a review of the literature. Actas Dermosifiliogr. 2013;104:512–517.
- Cuozzo D. W., Benson P. M., Sperling L. C., Skelton H. G. 3rd. Essential syphilitic alopecia revisited. J Am Acad Dermatol. 1995;32(5 Pt 2):840–843.
- Friedli A., Chavaz P., Harms M. Alopecia syphilitica: report of two cases in Geneva. Dermatology. 2001;202:376–377.
- Скрипкин Ю. К., Бутов Ю. С. Клиническая дерматовенерология. Руководство для врачей. М.: Геотар-Медиа, 2009. C. 564–654. [Skripkin Yu. K., Butov Yu. S. Clinical dermatovenerology. The guidance for physicians. Moscow: Geotar-Media, 2009. P. 564–654. (In Russ.)]
- Doche I., Hordinsky M. K., Valente N. Y. S., Romiti R., Tosti A. Syphilitic Alopecia: Case Reports and Trichoscopic Findings. Skin Appendage Disord. 2017 Oct;3(4):222–224. Published online 2017 Jun 17. doi: 10.1159/000477415
- Ye Y., Zhang X., Zhao Y., Gong Y., Yang J., Li H. et al. The clinical and trichoscopic features of syphilitic alopecia. J Dermatol Case Rep. 2014 Sep 30;8(3):78–80. doi: 10.3315/jdcr.2014.1176. eCollection 2014 Sep 30.
- Lacarrubba F., Dall Oglio F., Nasca M. R. et al. Videodermoscopy enhances diagnostic capability in some forms of hair loss. Am J Clin Dermatol. 2004;5:205–208.
- Rudnicka L., Olszewska M., Rakowska A. Atlas of Trichoscopy. Dermoscopy in Hair and Scalp Disease. London: Springer-Verlag, 2012. P. 205–220.
- Jordaan H. F., Louw M. The moth-eaten alopecia of secondary syphilis, a histopathological study of 12 patients. American Journal of Dermatopathology. 1995;17:158–162.
- Nam-Cha S. H., Guhl G., Fernandez-Pena P., Fraga J. Alopecia syphilitica with detection of Treponema pallidum in the hair follicle. J Cutan Pathol. 2007;34:37–40.
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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).