Young man with unexplained hair loss
Topical antifungals had failed to improve the patchy hair loss on this patient’s head. The pattern of the alopecia and a closer look at his history provided valuable diagnostic clues.
Treat with penicillin
Treatment at any stage is important to prevent further progression and central nervous system or cardiac dissemination. The initial treatment for either primary or secondary (<1 year) syphilis is one injection of penicillin G 2.4 million units intramuscularly (IM). When treating symptoms of more than a year’s duration, the injection is repeated once a week for 3 consecutive weeks. For patients who are allergic to penicillin, oral doxycycline 100 mg twice daily or tetracycline 500 mg 4 times daily can be used for 2 weeks.3
Our patient received a single dose of penicillin G 2.4 million units IM. The result was complete resolution of his alopecia. He was retested at 6 months and there was an appropriate drop in titer. Infectious disease specialists were notified on the day of diagnosis, and the patient’s partner was also contacted for testing and treatment. Both patients were counseled on safe sex practices.
CORRESPONDENCE
Jeffrey Kinard, DO, 31 AMDS/SGPF, APO, AE, 09604; jeffrey.kinard.1@us.af.mil.
