Dermatol. praxi. 2018;12(3):143-145 | DOI: 10.36290/der.2018.025

Secondary syphilis presenting as papulosquamous rash in a 55-year‑old pacient

MUDr. Šárka Kozojedová

Medicentrum Beroun, s. r. o.

Dermatovenerologické oddělení FN v Motole, Praha

Secondary syphilis begins usually in the ninth week (3–12 weeks) after the primary infection, with the onset of the rash. It is amanifestation of hematogenous dissemination of infection. At the beginning, primary ulcer ( or scar) with lymphadenopathymay be present. In some cases flu-like symptoms, generalized lymphadenopathy occur. Due to the inicial place of infection entrywe are more likely to experience inguinal lymphadenopathy with multiple enlarged nodes in the groin. The rash is not itchyusually. It´s symmetrical, disseminate, beginning on the trunk progressing to the limbs. Exanthema can also affect the genitals,rarely a forehead, a face, a hairy part of the head. The predominant type of exanthema is roseola (macular, monomorphic rash,with brown-pink discrete macules without peeling in embolization localization, in some cases it affects palms and soles). We seemaculopapular and papular rash less often. And then the following described skin and mucosal manifestations (condylomatalata, plaques on mucous membrane of the mouth, angina syphilitica, alopecia). A more pronounced or atypical progression ofsecondary syphilis usually indicates the patient‘s reduced immunity (most often HIV coinfection, but also for example ongoinghepatitis). In the second stage we should exclude early neurolues and syphilitic ocular conditions. HIV positive in particular havea significantly higher risk of affection of the nervous system in the early stages of infection. Other organes are rarely affected(syphilitic hepatitis, glomerulonephritis). The rash of the second stage of syphilis can be confused with a number of dermatoses,but they often show certain signs that should lead us to the correct diagnosis.

Keywords: secondary syphilis, lues secundaria papulosquamosa, roseola, psoriasiform syphilis

Published: October 10, 2018  Show citation