Psoriasiform secondary syphilis

    Article Contributors: 
    Sean Klepper M.D.
    Stephen Lyle, M.D., ...

    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: Teaching Collection