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| Fig. 28.7 Tertiary cutaneous syphilis demonstrating characteristic annular appearance with mild central atrophy. (Courtesy of Richard Gentry, MD.) |
Late benign syphilis usually occurs 1 to 46 years after resolution of the secondary skin lesions. Although almost any organ may be involved, the most common organ is the skin (70%) followed by the mucous membranes (10%) and bones (10%). The primary lesion of late benign syphilis is the
gumma. A gumma is a granulomatous lesion that contains treponemes only rarely; it probably represents a hypersensitivity reaction.
The skin lesions of late benign syphilis present as nodules and plaques that demonstrate a tendency for central healing and peripheral extension. The central healed areas characteristically demonstrate scarring and atrophy (Fig. 28-7). The mucosal lesions may involve any mucosal surface but demonstrate a tendency to extend to and destroy the nasal cartilage, producing a “saddle nose” deformity. Involvement of the mucosa over the hard palate may produce a perforation.
Rocha N, Horta M, Sanches M, et al: Syphilitic gumma—cutaneous tertiary syphilis,
J Eur Acad Dermatol Venereol 18:517–518, 2004.
