Sean Klepper M.D.
Stephen Lyle, M.D., ...
- Skin lesions in secondary syphilis usually present as disseminated red-brown macules, papules and papulosquamous lesions resembling the lesions of guttate psoriasis.
- Rarely, pusules develop.
- Alopecia, anogenital condylomata lata and pitted hyperkeratotic palmoplantar papules (syphilis cornee) may also be seen.
- In severe cases, ulcerative lesions termed lues maligna may develop.
- Epidermal changes:
- Basal vacuolar change
- exocytosis of lymphocytes
- Spongiform pustulation
- Psoriasiform hyperplasia may be seen in biopsies of papulosquamous lesions.
- Dermal Changes:
- Papillary dermal edema
- Superficial and deep perivascular and periadnexal lymphohistiocytic infiltrates, with or without plasma cells, developing into frank granulomas in older lesions
- The infiltrate may become lichenoid as the the lesion progresses.
- Approximately half of cases show obliterative endovasulopathy with endothelial swelling and mural edema.
- Lues maligna shows ulceration, endarteritis obliterans at the dermal-subcutaneous junction, ischemic necrosis and a dense plasmacytic and histiocytic infiltrate.
- Silver stains are positive for spirochetes only about one third of the time, but immunofluorescent microscopy is universally positive.