Alopecia as unique clue to syphilis in a patient

Alopecia is an uncommon manifestation of syphilis, simulating other common forms of hair-loss, but representing a crucial complaint for the patient, who might by converse have not noticed other signs and symptoms of the disease. Esthetic issues undervaluation might prolong illness, and postpone appropriate treatment. A 42-year-old patient, HIV negative, presented with a 2-month history of progressive generalized thinning of the hairs and small non-scarring irregular alopecia patches of the parietal-occipital areas of the scalp. The patient was under sertraline hydrochloride therapy for a recent diagnosis of bipolar disorder, and expressed the concern that the drug was causing the hair-loss. Accurate anamnesis and visiting of the patients revealed asymptomatic pale pink speckles of the trunk and limbs, and a bilateral psoriasis-like palmo-plantar hyperkeratosis, suggestive of secondary syphilis, further confirmed by serology. Specific antibiotic treatment healed all skin and scalp manifestations, but also the moodiness disorders, which allowed complete psychiatric drug dismissing. Skilled expertise and careful patient's examination are the clue to recognize minimal signs of serious systemic disease, such as syphilis, considered disappeared for decades. The risk of minimizing esthetic complaints, such as hair-loss can deceive a not trained eye, or escape in busy daily practice. Physicians should maintain a high level of clinical suspicion to contain the disease burden, especially among heterosexual apparently not at risk patients.