Rule out these other potential causes of hair loss
The differential diagnosis for syphilis alopecia includes alopecia areata, telogen effluvium, trichotillomania, and tinea capitis.
Alopecia areata is characterized by the rapid loss of sharply defined round/oval areas of hair, and is often seen in children and young adults with a family history of autoimmune disorders.4 Topical or intralesional steroid injections are used for treatment, although the condition can self-resolve.
Telogen effluvium is sudden diffuse hair loss following a major stressor (such as childbirth, a “crash” diet, or severe illness).4 The hair loss often stops when the underlying event has passed.
Trichotillomania is recurrent hair pulling that results in patches of hair loss with irregular and angulated borders.4 Treatment usually consists of behavioral modification and psychotherapy.
Tinea capitis is caused by the invasion of hair shafts by fungal hyphae. Findings range from small, round, scaly areas of alopecia to large, inflamed, boggy lesions (kerions). Fungal hyphae are visible on a potassium hydroxide preparation. Treatment includes oral antifungals and topical selenium sulfide or ketoconazole shampoo.2,4