Table 1. Clinical differential diagnosis of moth-eaten alopecia syphilitica
Condition |
Clinical Presentation |
Pathology |
Lab |
Treatment |
Alopecia areata |
Exclamation mark hairs |
A “swarm of bees” appearance of T lymphocyte infiltrates in the peribulbar region |
CBC 2, TFT, Thyroid antibodies |
Corticosteriods (intralesional, systemic, or topical) |
Alopecia neoplastica |
Presents months to years after diagnosis of primary malignancy |
Infiltration of tumor cells from primary malignancy |
Biopsy |
Treatment of primary malignancy |
Alopecia syphilitica |
Moth-eaten or diffuse pattern, or combination of both Other symptoms or lesions of secondary syphilis |
No dermoepidermal changes |
Serology |
Benzathine penicillin G |
Tinea capitis |
Erythematous patch with scaling |
Endothrix-hair shaft filled with hyphae and spores |
Culture KOH stain of scalp scrapings |
Systemic antifungals for 6-8 weeks |
Trichotillomania |
Irregular, localized patches |
Empty follicles with remnant hair bulb with exudates or hemorrhage |
Biopsy |
Parental support/education, Parental support/education, pharmacotherapy, depending on age and severity; may need psychiatric consultation |
1. CBC, complete blood count and platelets; KOH, potassium hydroxide; TFT, thyroid function test
2. If a macrocytic anemia is present, vitamin B12 level and patietal cell antibodies might be considered.