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Chapter 13: Syphilis

INTRODUCTION

KEY POINTS

  • Secondary syphilis can present with varying morphologies including macular, papular, papulosquamous, and annular plaques across skin colors.

  • On acral surfaces in lighter skin, it is often bright pink to red, while in darker skin, it tends to be brown to violaceous. Overlying scale may or may not be present.

  • On nonacral surfaces, in lighter skin, it tends to be pink to red, while in darker skin, it can be pink to brown to violaceous. Additionally, the annular variant can also have a hypopigmented peripheral rim.

image

FIGURE 13-1.

Violaceous papules coalescing centrally into plaques on the left palmar hand. (Reproduced with permission from Soutor C, Hordinsky MK. Clinical Dermatology. New York, NY: McGraw Hill; 2013, Figure 1-8A.)

The palm of a patient with several big dark papules due to secondary syphilis.
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FIGURE 13-2.

Bright-red papules and plaques scattered along the palmar hand and ventral wrist. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 225-15B. Reproduced with permission from Jonathan B. Karnes, MD.)

The palm of a patient with several red papules of varying sizes. The papules extend to the wrist as well.
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FIGURE 13-3.

Diffuse red papules and plaques on the neck, trunk, and upper extremities. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 225-15A. Reproduced with permission from Jonathan B. Karnes, MD.)

A patient with red papules spread all through the trunk, neck and arms.
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FIGURE 13-4.

Pink scaly papules and plaques of varying sizes scattered diffusely along the back. Note the dark-brown patches along the mid-lower and lateral back signifying postinflammatory changes. (Reproduced with permission from Soutor C, Hordinsky MK. Clinical Dermatology. New York, NY: McGraw Hill; 2013, Figure 12-6.)

A patient with hypopigmented Pink papules and plaques scattered across the back. They are of different sizes and some have gray to purple scales. Hyperpigmented Small dark brown patches are on the lower and lateral back.
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FIGURE 13-5.

Brown plaques with overlying silvery-white scale along the bilateral planter feet. (Reproduced with permission from Wolff K, Johnson RA, Saavedra AP, et al. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 8th ed. New York, NY: McGraw Hill; 2017, Figure 30-31.)

A patient with hyperpigmented brown plaques with white scaling on the plantar surface and medial sides of both feet.
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FIGURE 13-6.

Salmon-colored macules and patches on the bilateral plantar feet. (Reproduced with permission from Barnhill RL, Crowson AN, Magro CM, et al. Barnhill’s Dermatopathology, 4th ed. New York, NY: McGraw Hill; 2020, Figure 20-4A.)

The soles of a patient with secondary syphilis show small to moderate sized reddish papules scattered in the center.
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FIGURE 13-7.

Annular violaceous plaques with lighter pink raised borders on the face of a Latin American person. (From Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 95-57. Reproduced with permission from Parish LC, Brenner S, Ramos-e-Silva M, et al. Atlas of ...

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