Moth-eaten alopecia (MEA) is a characteristic manifestation of secondary syphilis. Clinically, this form of alopecia may be confused with trichotillomania, traction alopecia, and alopecia areata. The histopathological features of the latter conditions are well described, but information regarding the histology of syphilitic MEA is sparse. We systematically documented the histopathological features of 12 patients with MEA. Characteristic features included follicular plugging: a sparse, perivascular and perifollicular lymphocytic infiltrate; telogenization and follicleoriented melanin clumping.
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