Secondary syphilis - Hair and Scalp
See also in: Overview,Anogenital,Oral Mucosal LesionAlerts and Notices
Synopsis
Secondary syphilis can present with varied manifestations. Patients generally develop constitutional symptoms including malaise, appetite loss, fever, headache, stiff neck, myalgias, pharyngitis, and flu-like symptoms. Generalized lymphadenopathy is typically present. Cutaneous manifestations of secondary syphilis may include a generalized rash that includes the palms and soles. Condyloma lata (gray, broad, papular lesions) may be seen in moist anogenital locations or in the mouth. They are teeming with spirochetes and are, therefore, extremely infectious. Ocular symptoms may include lacrimation, photophobia, and red, painful eyes.
The second stage of syphilis can have varied manifestations with respect to the hair and scalp. Patchy alopecia with a "moth-eaten" appearance can be observed on the scalp and facial hair. Telogen effluvium can be present. Syphilitic papules may line the scalp margin, known as corona veneris.
The lesions of secondary syphilis resolve in 3-12 weeks, with or without treatment. If left untreated, up to 25% of patients will relapse within the first 2 years.
Immunocompromised patient considerations: HIV infection can alter the clinical presentation of syphilis. Manifestations include multiple chancres, atypical cutaneous eruptions, increased severity of organ involvement (such as hepatitis and glomerulonephritis), and rapidly developing arteritis and neurosyphilis. Neurosyphilis can occur at any stage of syphilis.
Related topics: primary syphilis, tertiary syphilis, early congenital syphilis, late congenital syphilis, ocular syphilis
Codes
ICD10CM:A51.39 – Other secondary syphilis of skin
SNOMEDCT:
240557004 – Secondary syphilis
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Differential Diagnosis & Pitfalls
The following differential will be focused on the cutaneous findings of secondary syphilis.Patchy alopecia:
- Alopecia areata
- Traction alopecia
- Lichen planopilaris
- Tinea capitis – Check potassium hydroxide (KOH) test.
- Sarcoidosis
- Discoid lupus erythematosus
- Corona veneris
- Corona seborrheica – In seborrheic dermatitis, scalp involvement may spread past the anterior hairline.
- Pityriasis rosea – Look for herald patch, collarette of scale, and orientation of lesions (fir-tree pattern in skin tension lines).
- Pityriasis rubra pilaris – Look for orange-red, waxy-like keratoderma of the palms and soles; consider tissue biopsy.
- Guttate psoriasis – Systemic signs absent, palms and soles are spared; biopsy will aid in diagnosis.
- Lichen planus – Very pruritic, violaceous, scaly papules, associated with hepatitis C; consider tissue biopsy.
- Lichen amyloidosis – Monomorphous papules.
- Drug eruption – Cutaneous lesions of drug eruption tend to be different than those seen in syphilis. Drug eruptions often present with urticarial, exanthematous, or vesicular / bullous lesions. Eosinophilia on CBC and histology are often seen (but eosinophilia is not an invariable finding). Look for NSAIDs, sulfonamides, and penicillin on medication history.
- Erythema multiforme – Characteristic target lesions (3 concentric colors that are round and well demarcated) occur on the extremities more often than the trunk. Precipitating factors are infectious (eg, herpes simplex virus, mycoplasma) and usually not medication related.
- Reactive arthritis (Reiter syndrome)
- Tinea corporis – Check potassium hydroxide (KOH) test.
- Scabies – Check for scabies mites in mineral oil.
- Sarcoidosis
- Mycosis fungoides
- Granuloma annulare
- Subacute cutaneous lupus erythematosus
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Last Reviewed:09/02/2020
Last Updated:08/18/2021
Last Updated:08/18/2021
Patient Information for Secondary syphilis - Hair and Scalp
Overview
Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. Secondary syphilis is the second of four stages of syphilis infection and it occurs typically 1-3 months after the first stage of syphilis. All patients who contract syphilis will go on to develop secondary syphilis if the infection is not treated.Who’s At Risk
You can get syphilis by having unprotected vaginal, anal, or oral sex.According to the US Centers for Disease Control and Prevention (CDC), secondary syphilis rates have increased since 2005 among men and men who have sex with men. An increase in syphilis cases has been reported in the United States in black and Hispanic individuals, sex workers, individuals who expose themselves to sex workers, and individuals with a medical history of other STIs.
Signs & Symptoms
Secondary syphilis typically includes skin rashes and sores in your mouth, anus, penis, or vagina. The rash often appears as red or brown, rough-looking spots on the palms or bottoms of feet. Other symptoms can include fever, sore throat, headaches, weight loss, fatigue, muscle aches, and hair loss.Self-Care Guidelines
To reduce your chances of contracting syphilis, use a condom when having sex. Also, consult your partner(s) prior to having sex about their risk of infection.When to Seek Medical Care
Seek medical care if you experience any of the symptoms of syphilis. You should be tested for syphilis routinely if you are a man who has sex with men, are pregnant, have HIV, or have a partner infected with syphilis.Even if symptoms subside, without treatment, secondary syphilis can turn into tertiary syphilis, which can involve the brain and the heart with very serious side effects.
Treatments
Syphilis must be treated with penicillin. If you are allergic to penicillin, you will need to be desensitized to it. You should also be tested for HIV infection. Syphilis can be completely cured, but only with treatment.Secondary syphilis - Hair and Scalp
See also in: Overview,Anogenital,Oral Mucosal Lesion