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To the Editor:
Secondary syphilis may manifest as syphilitic alopecia (SA), a non-scarring alopecia with a prevalence ranging from 3% to 22%.1 Examination of the hair using a dermatoscope, a non-invasive bedside test known as trichoscopy, may help differentiate SA from other forms of hair loss.2 3 This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to summarise published data on trichoscopic findings of SA (PROSPERO CRD42018092159).
Details of the searches (from inception to 22 April 2021), study selection, data extraction and quality assessment are provided in online supplemental figure 1 and online supplemental tables 1 and 2. Across 16 studies, 23 patients (96% male, mean age 34 years) were reported (table 1). The average time to presentation was 2 months. Moth-eaten and diffuse patterns of alopecia were seen in 78% and 22% of patients respectively; no studies reported a mixed pattern of alopecia. Essential SA (alopecia as an isolated presentation of syphilis) was reported in 35% of patients.
Patients presented with non-specific trichoscopic findings of decreased hairs per follicular unit (n=17, 74%), vellus …
Handling editor Tristan J Barber
Contributors HYS performed the literature search and data extraction, assessed included articles for methodological quality, wrote the first draft of the introduction, methodology and results, and revised several drafts of the manuscript. XLW performed the literature search and data extraction, reviewed the details of the systematic review, and reviewed many drafts of the manuscript. MKYC reviewed the included studies and broader literature on trichoscopic findings of syphilitic alopecia, drafted the discussion and conclusion, revised multiple drafts of the manuscript, and prepared the manuscript for submission to Sexually Transmitted Infections. DFS had significant contribution to the conception of the systematic review, mediated discrepancies during the acquisition and evaluation of data, obtained the image used for figure 2, and reviewed and revised many drafts of the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.