Practical Dermoscopy
Patchy Hair Loss
Alopecia parcheada
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"apellidos" => "Comunión-Artieda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "A." "apellidos" => "Martin-Gorgojo" "email" => array:1 [ 0 => "alejandromartingorgojo@aedv.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de ITS/Dermatología, Sección de Especialidades Médicas, Ayuntamiento de Madrid, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Alopecia parcheada" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1520 "Ancho" => 1345 "Tamanyo" => 422393 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy images with polarized light (obtained using the Fotofinder® digital dermatoscope). Top panel: 20× magnification. Bottom panel: 30× magnification. Focal alopecia, broken hairs of uniform length, short, vellus regrowth hair, and yellow spots.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 22-year-old man visited our department for assessment of loss of patches of hair that had begun 2 weeks earlier. Physical examination revealed small areas of alopecia distributed in the temporal and occipital regions, with no accompanying erythema or scaling (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">What is Your Diagnosis?</p><p id="par0010" class="elsevierStylePara elsevierViewall">Syphilitic alopecia.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0015" class="elsevierStylePara elsevierViewall">Dermoscopy findings are shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. A directed history allowed for clinical suspicion of secondary syphilis. Serology positive for treponema and with an RPR titer of 1/16 confirmed this diagnosis.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Syphilitic alopecia is a rare clinical manifestation of secondary syphilis. Depending on its pattern (moth-eaten or diffuse), it may produce clinical findings similar to those of other nonscarring alopecias, such as alopecia areata, trichotillomania, or telogen effluvium. It is considered to be essential syphilitic alopecia when no evidence of other mucocutaneous disease exists (as in our case), which make diagnosis difficult.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Few dermoscopic findings of syphilitic alopecia have been described in the literature to date. In 2014, Ye et al. first described trichoscopy in a patient with moth-eaten syphilitic alopecia, in which they identified black spots, focal alopecia, hypopigmentation of the hair shaft, and yellow spots.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Subsequent descriptions include yellow spots, vellus hair, sharp, bent, broken, or zigzag hairs, dilated and tortuous blood vessels with slight extravasation of blood, a brownish-erythematous background, and perifollicular hyperkeratosis.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The most common dermoscopic findings in alopecia areata include black spots, exclamation point hairs, short regrowth hairs, and yellow spots. In trichotillomania, the most common finding is broken hairs of different lengths.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Broken hairs are the result of irregular transversal fracture of the terminal hair, weakened by an inflammatory process or by the rapid growth of a hair that has not been completely destroyed. Molecular studies have made it possible to identify the bacterium <span class="elsevierStyleItalic">Treponema pallidum</span> in the affected follicles.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> While the pathophysiology is not clear, it is thought that the presence of <span class="elsevierStyleItalic">T. pallidum</span> or the immune response to this bacterium may cause vasculitis of small vessels and damage to the follicle, with a loss of terminal hair and interruption of the hair-follicle growth cycle, which results in the presence of empty follicles and broken hairs.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In this case of essential moth-eaten essential syphilitic alopecia, dermoscopy supported the suspected diagnosis (given the absence of criteria for other possible clinical diagnoses) and made it possible to speed up treatment (an antibiotic was prescribed at the time of the initial assessment). Dermoscopy is a useful, noninvasive, and rapid method that can help to diagnose a suspected syphilitic alopecia, although serological tests is essential for a definitive diagnosis.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Description" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Comment" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of Interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 452 "Ancho" => 1000 "Tamanyo" => 156939 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical presentation of the case. Left panel: occipital region. Right panel: right parietotemporal region.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1520 "Ancho" => 1345 "Tamanyo" => 422393 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy images with polarized light (obtained using the Fotofinder® digital dermatoscope). Top panel: 20× magnification. Bottom panel: 30× magnification. Focal alopecia, broken hairs of uniform length, short, vellus regrowth hair, and yellow spots.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The clinical and trichoscopic features of syphilitic alopecia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Ye" 1 => "X. Zhang" 2 => "Y. Zhao" 3 => "Y. Gong" 4 => "J. Yang" 5 => "H. 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| 2024 Enero | 80 | 37 | 117 |
| 2023 Diciembre | 71 | 24 | 95 |
| 2023 Noviembre | 102 | 47 | 149 |
| 2023 Octubre | 118 | 41 | 159 |
| 2023 Septiembre | 100 | 38 | 138 |
| 2023 Agosto | 96 | 21 | 117 |
| 2023 Julio | 119 | 39 | 158 |
| 2023 Junio | 81 | 25 | 106 |
| 2023 Mayo | 110 | 23 | 133 |
| 2023 Abril | 61 | 24 | 85 |
| 2023 Marzo | 82 | 35 | 117 |
| 2023 Febrero | 79 | 25 | 104 |
| 2023 Enero | 69 | 45 | 114 |
| 2022 Diciembre | 82 | 59 | 141 |
| 2022 Noviembre | 84 | 44 | 128 |
| 2022 Octubre | 99 | 38 | 137 |
| 2022 Septiembre | 83 | 48 | 131 |
| 2022 Agosto | 74 | 62 | 136 |
| 2022 Julio | 70 | 38 | 108 |
| 2022 Junio | 62 | 52 | 114 |
| 2022 Mayo | 183 | 70 | 253 |
| 2022 Abril | 67 | 42 | 109 |
| 2022 Marzo | 125 | 70 | 195 |
| 2022 Febrero | 31 | 124 | 155 |
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