Pille Konno, Airi Põder
Tartu University, Estonia
Corona is the keyword of the year 2020. Corona means a circular crown, from the Latin word for “crown or garland”.
Corona Veneris is a well-known expression in venereology, and we know corona psoriatica, corona seborrhoica, corona alopecia patterned hair loss also. Penil corona involvement in dermatology is common.
Crown of Venus sign describes maculopapular syphilitic lesions that can involve seborrheic regions, and on the forehead resembling a crown-like pattern and called “Corona Veneris”. The similar lesions might occur on the neck also (called the collar Venus or leukoderma). These lesions may lead to the diagnosis of secondary syphilis.
Syphilitic alopecia is rare, occurs in only 4% of patients with syphilis. In 1940, McCarthy described two types of secondary syphilitic alopecia, and that classification continues to be used to this day. An extremely rare manifestation is papulosquamous lesions on the scalp. The second type is characterized by hair loss with no other visible syphilitic lesions on the scalp. There are three clinical patterns: moth-eaten or patchy alopecia, diffuse or mixed-pattern alopecia. Moth-eaten pattern is the most common and is characterized by the presence of small scattered plaques of nonscarring alopecia that are not completely hairless and show no signs of inflammation or desquamation. They occur mainly in the parieto-occipital region, possibly due to a greater load of treponemes because of the rich local blood supply to this area, but they can also arise in other areas of hairy skin, such as the beard, eyelashes, axillas, pubis, trunk or on the legs.
Nowadays, dermoscopy and trichoscopical examination are very helpful in recognizing special patterns for differential diagnosis. Trichoscopy showed black dots, focal atrichia, hypopigmentation of the hair shaft, and yellow dots. The clinical and trichoscopic features of syphilitic alopecia are vellus hairs, empty hair follicles, follicular hyperkeratosis, peripheral black spots, hypopigmented hairs, and dilated and tortuous vessels were visualized on an erythematous-brown background.
Laboratory examinations, treponemal and nontreponemal tests positivity, leads to the diagnosis. Immunohistochemical staining revealed the presence of numerous spirocytes in the hair follicles. The histology of lesions usually shows preservation of the epidermis with areas of follicular hyperkeratosis. Syphilitic alopecia should be classified as a nonscarring inflammatory alopecia with the presence of a perivascular and perifollicular lymphohistiocytic dermal infiltrate with plasma cells. Benzathine penicillin G (2.4 million units intramuscularily) is still the main treatment agent for secondary syphilis.
Take home message - the importance of skin manifestations. Remember that there are other diseases besides COVID-19. Syphilis has not disappeared. A high clinical suspicion, notice minimal skin changes and signs of alopecia and may lead to the diagnosis of syphilis, especially if it is the only symptom.
34 IUSTI Congress - European Congres on Sexually transmitted Infections and HIV/AIDS
TAMING THE TIDE of STIs & HIV
Bucharest, September 3-5,