Moth-eaten and diffuse syphilitic alopecia in an HIV-positive patient: Clinical and trichoscopic features

Hair loss in HIV-positive patients can result from various causes, including syphilitic alopecia (SA), a rare manifestation of secondary syphilis. We describe the case of a 31-year-old male on antiretroviral therapy who presented with moth-eaten alopecia – multiple irregular, nonscarring scalp patches – along with signs of secondary syphilis. Trichoscopy revealed focal atrichia, yellow dots, vellus, and broken hairs. Serological tests confirmed syphilis ( Treponema pallidum hemagglutination assay 1:1280; Venereal Disease Research Laboratory 1:4), and neurosyphilis was excluded through lumbar puncture. The patient improved clinically and biologically after intramuscular benzathine penicillin G. Trichoscopy played a key role in differentiating SA from other nonscarring causes of hair loss.