Papulosquamous lesions on the palms. (Courtesy Steven H Goldberg, M
About 8 weeks after the primary infection, lesions of secondary syphilis may develop. See also lues maligna.
The rash of secondary syphilis is diffuse and often involves the palms and soles. Lesions are symmetric and coppery red in color. Itch is uncommon. There is no herald patch as in pityriasis rosea. Many morphologies are possible including macular (roseolar), papular, papulosquamous, annular, nodular, pustular, and ulcerative. Other changes include moth-eaten alopecia, alopecia of the eyebrows, condyloma lata (moist plaques occurring perianally and genitally, mucous patches, paronychia, and split papules at the corners of the mouth.
The Syphilis Health Check test which uses a finger-stick blood sample has been approved by the FDA for use in the US by health care workers without special training. It takes only 12 minutes. If positive, a confirmatory blood test should be drawn.
The latest public health recommendations should be consulted. Previous recommendations include 2.4 million units of benzathine penicillin once intramuscularly. For those allergic to penicillin, the preferred treatment is desensitization to penicillin and subsequent penicillin treatment.
Nodular secondary syphilis in an HIV-positive patient reminiscent of split papules. The first picture is at presentation. The second is acute enlargement days after biopsy. The lesion melted away 3 days after penicillin treatment.
Annular lesions as well as condyloma lata. Virtual Grand Rounds in Dermatology
Moth-eaten alopecia. Dermatology Online Journal
Secondary Syphilis presenting as multiple ulcers for 3 weeks in an HIV positive man. Dermatology Online Journal 21(3)
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