Question

A 30-year-old patient presents with a history of flat lesions near the anal canal, rashes on the body, and hair loss that follows a particular pattern, as shown in the image. What is the diagnosis? 

• A. Trichotillomania
• B. Alopecia areata
• C. Secondary syphilis
• D. Malassezia

Hint:

In cases of secondary syphilis, remember the characteristic rash, mucosal lesions, and distinctive hair loss pattern. Confirm with serologic testing for syphilis.

Answer 1

The Correct Option is C

Step 1: Group the three clinical clues into one syndrome.
A young adult presents with (a) flat lesions around the anal canal, (b) a generalised body rash, and (c) patterned hair loss. The task is to find the single condition that explains all three at once, rather than a diagnosis that fits only one.

Step 2: Decode each finding.
• Flat, moist, broad-based lesions near the anus are condylomata lata.
• A widespread, typically non-itchy rash that can extend to the palms and soles is a classic disseminated eruption.
• Patterned, patchy, non-scarring hair loss is the "moth-eaten" alopecia.

Step 3: Identify the unifying disease.
This triad - condylomata lata + a palm-and-sole rash + moth-eaten alopecia - is the textbook picture of secondary syphilis, the disseminated stage of infection with the spirochaete Treponema pallidum that follows the primary chancre.

Step 4: Test the rival options against the full picture.
• Trichotillomania is compulsive hair-pulling; it gives irregular bald areas but produces no anogenital lesions and no body rash.
• Alopecia areata gives smooth, discrete bald patches only - no rash, no anal lesions.
• Malassezia (pityriasis/tinea versicolor) causes scaly hypo- or hyperpigmented trunk macules and does not cause anal condylomata or alopecia.
Only secondary syphilis ties all three features together.

Final answer: The diagnosis is Option 3 - Secondary syphilis.