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Syphilitic Alopecia
Unless a chancre is located on the scalp, hair loss does not occur in primary syphilis. In secondary syphilis, the most typical presentation is a โmoth-eatenโ pattern of alopecia with multiple, small, ill-defined hairless patches primarily in the parieto-occipital region of the scalp. Hair loss may also occur in the eyebrows, beard, and other hair-bearing sites. Diffuse scalp alopecia, as in telogen effluvium, is less common. A third type of hair loss is seen within nodulo-ulcerative skin lesions of lues maligna; they heal with scarring, leading to secondary cicatricial alopecia. In tertiary syphilis, hair loss may occur within cutaneous gummas.