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| Fig. 28.5 Secondary syphilis. A, Hyperpigmented macules of secondary syphilis in a patient who was initially treated for chancroid. Note the strong similarity of these lesions to pityriasis rosea. B, Characteristic papulosquamous lesions of secondary syphilis on the palm of a nurse. Macular or papulosquamous lesions on the palms are not diagnostic but are suggestive of secondary syphilis. C, Annular lesions of secondary syphilis on the face. D, Striking annular lesions of the chest in a patient with secondary syphilis. (Panel B courtesy of the Fitzsimons Army Medical Center teaching files; panel D courtesy of the Walter Reed Army Medical Center teaching files.) |
The syphiloderm of secondary syphilis is most commonly a maculopapular dermatitis (Fig. 28-5A, B) with variable scaly (70%), papular (12%), or macular (10%) lesions. Less common morphologic appearances include annular (Fig. 28-5C, D), pustular, and psoriasiform lesions. The rash typically demonstrates a widespread symmetrical distribution, although in some patients, lesions may be localized to a single anatomic region, such as the palms and soles. In a large study done in the United States, the most common sites of involvement, in descending order, were the soles, trunk, arms, genitals, palms, legs, face, neck, and scalp.
Dave S, Gopinath DV, Thappa DM: Nodular secondary syphilis,
Dermatol Online J 9:9, 2003. (Readers can go to this journal online and see clinical photographs.)
