Moth-Eaten Alopecia of the Scalp and Beard as a Manifestation ofSecondary Syphilis: A Diagnostic Challenge

Abstract

Syphilis, caused by Treponema pallidum, remains a diagnostic challenge because of its highly variable clinical manifestations that often mimic otherdermatologic conditions. We report a case of secondary syphilis presenting with moth-eaten alopecia of the scalp and beard in a middle-aged man.The condition was initially mistaken for alopecia areata, delaying effective treatment. Trichoscopy showed nonspecific findings, but serologic testingconfirmed the diagnosis. Benzathine penicillin therapy led to progressive hair regrowth and clinical resolution. This case underscores the importanceof considering syphilis in the differential diagnosis of nonscarring alopecia and highlights the role of serology in avoiding misdiagnosis, unnecessarytreatments, and ongoing disease transmission.