Clinical Features:

• 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.

Histologic Features:

• Epidermal changes:
  • Sspongiosis
  • Basal vacuolar change
  • exocytosis of lymphocytes
  • Spongiform pustulation 
  • Parakeratosis.
  • 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.

Cases associated with this book:

Secondary syphilis
Author: Stephen Lyle, M.D., Ph.D.

Conference: DermatopathologyConsultations.com Teaching Collection