Images in Dermatology
Dermatoscopic findings of syphilitic alopecia
a Department of Dermatology, Hospital de Doenças Tropicais Dr. Anuar Auad, Goiânia, GO, Brazil
b Department of Tropical Medicine and Dermatology, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO, Brazil
c Sector of Psoriasis and Pediatric Dermatology, Hospital de Doenças Tropicais Dr. Anuar Auad, Goiânia, GO, Brazil
d Department of Dermatology and Radiotherapy, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, São Paulo, SP, Brazil
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Pruritic erythematosquamous lesion in the auricle" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "521" "paginaFinal" => "523" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 573 "Ancho" => 755 "Tamanyo" => 113761 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A and B) After 25 days of treatment, and at the end of ten weeks.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elaine Dias Melo, Patrícia Motta de Morais, Débora Cristina de Lima Fernandes, Paula Frassinetti Bessa Rebello" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Elaine Dias" "apellidos" => "Melo" ] 1 => array:2 [ "nombre" => "Patrícia Motta de" "apellidos" => "Morais" ] 2 => array:2 [ "nombre" => "Débora Cristina de Lima" "apellidos" => "Fernandes" ] 3 => array:2 [ "nombre" => "Paula Frassinetti Bessa" "apellidos" => "Rebello" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220301946" "doi" => "10.1016/j.abdp.2020.05.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301946?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962030129X?idApp=UINPBA00008Z" "url" => "/03650596/0000009500000004/v3_202008041755/S036505962030129X/v3_202008041755/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0365059620301410" "issn" => "03650596" "doi" => "10.1016/j.abd.2019.10.008" "estado" => "S300" "fechaPublicacion" => "2020-07-01" "aid" => "213" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Dermatology</span>" "titulo" => "Trichoscopic stages of dissecting cellulitis: a potential complementary tool to clinical assessment" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "514" "paginaFinal" => "517" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1117 "Ancho" => 1674 "Tamanyo" => 325147 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Early stage of dissecting cellulitis, with trichoscopy findings on alopecia areata. 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A, Empty hair follicles; B, Vellus hair C, Perifollicular hyperkeratosis; D, Black point on the periphery; E, Dilated and tortuous vessels; F, Erythematous-brownish background; G, Hypopigmentation of the hair shafts.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Syphilis is an infectious disease that has afflicted mankind for centuries. Epidemiological data show that the incidence has increased over the last years throughout the world.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> It is primarily a sexually transmitted disease. In addition, pregnant women can transmit the infection to their unborn child, characterizing congenital syphilis. The disease typically follows a progression through stages: primary syphilis (sore on or around the genitals), secondary syphilis (rash may appear as rough, red, or reddish brown spots both on the palms and soles, among other less common sites), and tertiary syphilis (affecting multiple organ systems, including the brain, nerves, heart, and blood vessels, among others).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3</span></a> The secondary stage may be accompanied by syphilitic alopecia (SA), whose prevalence may be underestimated due to its subtle presentation and difficult diagnosis. Dermoscopy is a useful tool to differentiate various hair diseases.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4–6</span></a> The present report describes a patient with typical lesions of secondary stage and SA, whose dermoscopic diagnosis was compatible with other findings in the literature, but with the peculiarity of showing an erythematous background more evident than the cases previously described.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 29-year-old man, infected by HIV five years ago, had been using antiretroviral therapy with a history of poor adherence. His last CD4 demonstrated 674<span class="elsevierStyleHsp" style=""></span>cells and a viral load of 417<span class="elsevierStyleHsp" style=""></span>copies. He presented erythematous-brown, infiltrated plaques on the face, trunk, and arms, as well as areas of multiple non-healing alopecia, with poorly defined borders, present in the occipital region of the scalp (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A biopsy of the cutaneous lesion was performed. The anatomopathological examination described an intact epidermis, a dermis with superficial and deep perivascular neural inflammatory lymphohistiocytic infiltrate, presence of foci of inflammatory aggression to nervous filaments, and formation of epithelioid granulomas, without Langhans giant cells. He had been diagnosed with syphilis, with Venenearal Disease Research Laboratory test (VDRL)<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1/512. The dermoscopy (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>) of the scalp lesions revealed empty hair follicles (3A), vellus hair (3B), follicular hyperkeratosis (3C), peripheral black dots (3D), dilated and tortuous vessels (3E), reddish-brown background (3F), and depigmented capillaries (3G). He was treated with benzathine penicillin, evolving with prompt regrowth in the areas of alopecia.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">SA is an uncommon manifestation of syphilis infection. In 1940, McCarthy described two clinical types of SA, symptomatic and essential, the latter being divided into three patterns: moth-eaten or patchy alopecia, diffuse alopecia, and mixed-pattern alopecia. This classification continues to be used, practically unchanged. Although the clinical aspects of SA are well described, the trichoscopic findings have been demonstrated in scant publications in recent years, detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">table 1</a>.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4–7</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Symptomatic SA is the most rare manifestation, in which there is an association of skin and scalp lesions, simultaneously. The essential SA is characterized by capillary loss, with no other visible syphilitic lesions. Moth-eaten alopecia is the most common, presented by multiple plaques of non-cicatricial alopecia, in the absence of local inflammation or scaling. They occur mainly in the parieto-occipital region, but may also arise in other areas such as beard, eyelashes, armpits, pubis, trunk, and legs. The diffuse SA is caused by capillary loss, like telogen effluvium. The mixed form is characterized by small irregular plaques that develop along with diffuse alopecia.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,8,9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">SA has several differential diagnoses, such as alopecia areata (the main differential diagnosis of the patient in question), lupus, trichotillomania, tinea capitis, lichen planus pilaris, and telogen effluvium.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,8</span></a> Clinical findings of cutaneous lesions associated with alopecia facilitate diagnosis, but cases with isolated alopecia may occur, making it difficult to diagnose SA.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Recent molecular studies have identified <span class="elsevierStyleItalic">Treponema pallidum</span> in the affected follicles, supporting the theory of a specific immune reaction to treponemal antigens. Immunohistochemistry can show the presence of spirochetes, generally in the peribulbar and perifollicular regions, indicating that this microorganism has a direct pathogenic role in alopecia.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient in the reported case has presented the rarest form of alopecia, called symptomatic, due to the presence of skin and scalp lesions simultaneously. At dermoscopy, the typical signs described in the literature, such as vellus hairs, empty hair follicles, follicular hyperkeratosis, peripheral black spots, hypopigmented hairs, and dilated and tortuous vessels were visualized on an erythematous-brown background. However, the most striking feature was erythema more intense than the others reported, which may correspond to a symptomatic lesion of secondary syphilis. Trichoscopy can facilitate the diagnosis of SA in a patient with capillary loss of unknown origin.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6,8</span></a> The clinical presentation, the serological screening for syphilis, and the histopathology of the scalp should be taken into account for the final diagnosis.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors’ contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Izabella Cristina Cardozo Bomfim: Approval of the final version of the manuscript; conception and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of the data; critical review of the literature; critical review of the manuscript.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Mayra Ianhez: Approval of the final version of the manuscript; conception and planning of the study; participation in the propaedeutic and/or therapeutic conduct of the cases studied; critical review of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Hélio Amante Miot: Approval of the final version of the manuscript; conception and planning of the study; critical review of the manuscript.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1370014" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1259086" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0025" "titulo" => "Financial support" ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Authors’ contributions" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-03-19" "fechaAceptado" => "2020-01-19" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1259086" "palabras" => array:3 [ 0 => "Alopecia" 1 => "Dermoscopy" 2 => "Syphilis" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Syphilis is an infectious disease that has afflicted mankind for centuries, but a recent increase in worldwide incidence has been evidenced. The authors describe a patient with typical lesions of secondary syphilis and moth-eaten alopecia, whose dermoscopic examination demonstrated empty hair follicles, vellus hair, follicular hyperkeratosis, peripheral black dots, dilated and tortuous vessels, reddish brown background, and hypopigmentation of the hair shafts. Furthermore, this case presented an erythematous background more evident than previously described cases.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Bomfim ICC, Ianhez M, Miot HA. Dermatoscopic findings of syphilitic alopecia. An Bras Dermatol. 2020;95:518–20.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital de Doenças Tropicais Dr. Anuar Auad, Goiânia, GO, Brazil.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 699 "Ancho" => 1007 "Tamanyo" => 142859 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Areas of non-scarring alopecia on the scalp.</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" => 727 "Ancho" => 1007 "Tamanyo" => 207369 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy of the areas of non-cicatricial syphilitic alopecia. * Dermatoscope: DermLite model DL3, ×10 magnification.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 823 "Ancho" => 1007 "Tamanyo" => 192312 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy of the areas of non-cicatricial syphilitic alopecia. A, Empty hair follicles; B, Vellus hair C, Perifollicular hyperkeratosis; D, Black point on the periphery; E, Dilated and tortuous vessels; F, Erythematous-brownish background; G, Hypopigmentation of the hair shafts.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author (year) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dermoscopic findings \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tognetti et al. (2017) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Empty ostia and yellow dots are visible in the center of the alopecic patches over an erythematous background. Tapered bent hairs are present at the periphery of the alopecic patches. Vellus hairs are visible at the periphery. Scales appear to be thin and whitish; perifollicular hyperkeratosis is focally visible. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Doche et al. (2017) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reduction of the number of hairs, yellow dots, broken and zigzag hair. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Piraccini et al. (2015) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reduction in the number of terminal hairs and the presence of empty hair follicles, vellus hairs, red-brown background, and irregularly dilated capillaries with slight blood extravasation in four patients. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ye et al. (2014) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Black dots, focal atrichia, hypopigmentation of hair shafts and yellow dots, and the scalp showed no obvious signs of inflammation or desquamation. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Review of all reported results</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="7" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yellow dots and black dots. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vellus hairs; curved, tapered, broken, or zigzag hairs. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypopigmentation of the hair shaft. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Empty hair follicles, reduction of terminal hairs. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dilated and tortuous vessels, slight extravasation of blood. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous or erythematous-brownish background \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perifollicular hyperkeratosis \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2352767.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic findings of syphilitic alopecia described in the literature.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Syphilis: diagnosis, treatment and control" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.C.R. Avelleira" 1 => "G. Bottino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2006" "volumen" => "81" "paginaInicial" => "111" "paginaFinal" => "126" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Syphilis in adult" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.T. Goh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/sti.2005.015875" "Revista" => array:6 [ "tituloSerie" => "Sex Transm Infect" "fecha" => "2005" "volumen" => "81" "paginaInicial" => "448" "paginaFinal" => "452" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16326843" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.A.P. Sampaio" 1 => "E.A. Rivitti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "2nd ed." "fecha" => "2001" "editorial" => "Artes Médicas" "editorialLocalizacion" => "São Paulo" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hair and scalp manifestations in secondary syphilis: epidemiology, clinical features and trichoscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.M. Piraccini" 1 => "A. Broccoli" 2 => "M. Starace" 3 => "V. Gaspari" 4 => "A. D’Antuono" 5 => "E. Dika" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000431314" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2015" "volumen" => "231" "paginaInicial" => "171" "paginaFinal" => "176" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26139324" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Syphilitic alopecia: uncommon trichoscopic findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Tognetti" 1 => "E. Cinotti" 2 => "J.L. Perrot" 3 => "M. Campoli" 4 => "P. Rubegni" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Dermatol Pract Concept" "fecha" => "2017" "volumen" => "7" "paginaInicial" => "12" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "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. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3315/jdcr.2014.1176" "Revista" => array:6 [ "tituloSerie" => "J Dermatol Case Rep" "fecha" => "2014" "volumen" => "8" "paginaInicial" => "78" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25324910" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Syphilitic alopecia: case reports and trichoscopic findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Doche" 1 => "M.K. Hordinsky" 2 => "N.Y.S. Valente" 3 => "R. Romiti" 4 => "A. Tosti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000477415" "Revista" => array:6 [ "tituloSerie" => "Skin Appendage Disord" "fecha" => "2017" "volumen" => "3" "paginaInicial" => "222" "paginaFinal" => "224" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29177154" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Syphilitic alopecia: a report of 5 cases and a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Hernández-Bel" 1 => "B. Unamuno" 2 => "J.L. Sánchez-Carazo" 3 => "I. Febrer" 4 => "V. Alegre" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2012.02.009" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2013" "volumen" => "104" "paginaInicial" => "512" "paginaFinal" => "517" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22749730" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and treatment of diseases of the hair" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. McCarthy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1940" "editorial" => "CV Mosby Company" "editorialLocalizacion" => "St. Louis" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histological diagnosis of inflammatory skin diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.B. Ackerman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1978" "editorial" => "Lea and Febiger" "editorialLocalizacion" => "Philadelphia" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009500000004/v3_202008041755/S0365059620301379/v3_202008041755/en/main.assets" "Apartado" => array:4 [ "identificador" => "80631" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009500000004/v3_202008041755/S0365059620301379/v3_202008041755/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620301379?idApp=UINPBA00008Z" ]
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