Syphilitic leucoderma
Syphilitic leukoderma or pigmentary syphilide was first described in 1854 by Hardy, and in 1883 the disease received its modern name. Leukoderma is one of the most characteristic symptoms of the disease. It occurs in both fresh and recurrent secondary syphilis and is characterized by the appearance of colorless spots on the side, back and front surfaces of the neck (“Venus necklace”).
Syphilitic leukoderma appears 4 to 6 months after infection. Its causes are profound neurophysiological changes, which are manifested by disorders of pigment formation. In 50 - 60% of patients with leukoderma, cerebrospinal fluid pathology is noted.
Most often, pigmentary syphilide is localized on the skin around the neck, but sometimes its location is noted on the anterior walls of the armpits, the area of the shoulder joints and the upper back. The chest, abdomen, limbs and lumbar region are rare locations.
At the beginning of the development of leukoderma, spots appear in the form of pale yellow hyperpigmentation with a diameter of 3 to 10 mm. Gradually, hyperpigmentation intensifies. Against its background, areas of depigmentation with rounded outlines appear. If depigmented spots are located in isolation, they speak of a spotted form of leukoderma. When spots merge, when the hyperpigmented background decreases, changes on the skin become lace-like - “lace” leucoderma. If the pigmentation around the depigmented spots is weakly expressed, they speak of “marbled” leucoderma.
Areas of syphilitic leukoderma never peel off, and there are no acute inflammatory phenomena. The patient's general condition remains satisfactory. Resistance to specific therapy is noted. There is leucoderma from several months to 4 years. Treponema pallidum is never detected in lesions.
Syphilitic leukoderma should be distinguished from pityriasis versicolor, vitiligo, plaque parapsoriasis, cicatricial atrophy, etc.
Rice. 1. Syphilitic leukoderma.
Rice. 2. A sign of secondary syphilis is leucoderma.
Pustular syphilide
Pustular syphilide, like vesicular syphilide, is rare, usually in weakened patients with low immunity and has a malignant course. When the disease occurs, the general condition of the patient suffers. Symptoms such as fever, headache, severe weakness, joint and muscle pain appear. Often, classical tests for syphilis give negative results.
Acne, smallpox, impetiginous, syphilitic ecthyma and rupiah are the main types of pustular syphilide. Rashes of this type are similar to dermatoses. Their distinctive feature is a copper-red infiltrate located along the periphery in the form of a roller. The occurrence of pustular syphilide is promoted by diseases such as alcoholism, toxic and drug addiction, tuberculosis, malaria, hypovitaminosis, and trauma.
Acne-like (acneiform) syphilide
The rashes are small pustules of a rounded conical shape with a dense base, located at the mouths of the follicles. After drying, a crust forms on the surface of the pustules, which falls off after a few days. A depressed scar remains in its place. The scalp, neck, forehead, and upper half of the body are the main locations for acne syphilide. Elements of the rash appear in large numbers during the period of early secondary syphilis, and scanty rashes appear during the period of recurrent syphilis. The general condition of the patient suffers little.
Acne syphilide should be distinguished from acne and papulonecrotic tuberculosis.
Rice. 14. Rash due to syphilis - acne syphilide.
Smallpox syphilide
Smallpox syphilide usually occurs in weakened patients. Pea-sized pustules are located on a dense base, surrounded by a copper-red ridge. When the pustule dries out it becomes like a smallpox element. In place of the fallen crust, brown pigmentation or an atrophic scar remains. The rashes are not abundant. Their number does not exceed 20.
Rice. 15. The photo shows manifestations of secondary syphilis - smallpox syphilide.
Impetiginous syphilide
With impetiginous syphilide, a dark red papule the size of a pea or more appears first. After a few days, the papule festeres and shrinks into a crust. However, the discharge from the pustule continues to be released to the surface and dries out again, forming a new crust. The layering can become large. The formed elements rise above the skin level. When syphilides merge, large plaques are formed. After peeling off the crusts, a juicy red bottom is exposed. Vegetative growths resemble raspberries.
Impetiginous syphilide, located on the scalp, nasolabial fold, beard and pubis, is similar to a fungal infection - deep trichophytosis. In some cases, the ulcers merge, forming large areas of damage (corrosive syphilide).
Healing of syphilide is long. Pigmentation remains at the site of the lesion, which disappears over time.
Impetiginous syphilide should be distinguished from impetiginous pyoderma.
Rice. 16. In the photo, a type of pustular syphilide is impetiginous syphilide.
Syphilitic ecthyma
Syphilitic ecthyma is a severe form of pustular syphilide. Appears 5 months after infection, earlier in weakened patients. Deep pustules are covered with thick crusts up to 3 or more centimeters in diameter; they are thick, dense, and layered. Elements of the rash rise above the surface of the skin. They have a round shape, sometimes irregular oval. After the crusts are rejected, ulcers with dense edges and a bluish rim are exposed. The number of ecthymas is small (no more than five). The main places of localization are the limbs (usually the lower legs). Healing occurs slowly, over 2 or more weeks. Ecthymas can be superficial or deep. Serological tests sometimes give negative results. Syphilitic ecthyma should be distinguished from vulgar ecthyma.
Rice. 17. Secondary syphilis. A type of pustular syphilide is syphilitic ecthyma.
Syphilitic rupee
A type of ecthyma is syphilitic rupee. The rashes range in size from 3 to 5 centimeters in diameter. They are deep ulcers with steep, infiltrated edges, covered with dirty and bloody discharge, which dry to form a cone-shaped crust. The scar heals slowly. It is often located on the shins. It spreads both peripherally and deeply. Combines with other syphilides. It should be distinguished from rupoid pyoderma.
Rice. 18. Rash due to secondary syphilis - syphilitic rupee.
Rice. 19. In the photo, the symptoms of malignant syphilis of the secondary period are deep skin lesions: multiple papules, syphilitic ecthymas and rupees.
Syphilitic alopecia
Syphilitic alopecia (pathological hair loss) occurs with secondary syphilis in 15 - 20% of cases. Some patients experience loss of eyelashes, eyebrow hair, mustache and beard. This pathology occurs in both fresh (early) and recurrent syphilis. Often combined with leucoderma.
The cause of small-focal syphilitic alopecia is a disorder of hair nutrition that develops as a result of inflammation caused by Treponema pallidum. The cause of diffuse syphilitic inflammation is considered to be intoxication, disruption of the endocrine and nervous systems resulting from exposure to a syphilitic infection. In all forms of alopecia, the hair follicle is not damaged, so 1 to 2 months after adequate treatment, the hair grows back.
With small focal alopecia, the patient has many small, round-shaped foci of baldness throughout the head, but the largest number of them is recorded at the temples and in the back of the head. Due to the fact that not all hair falls out on the affected areas, patches of baldness resemble moth-eaten fur. The skin does not become inflamed. There is no peeling or itching.
With diffuse alopecia, hair begins to fall out from the temple area and then the process spreads throughout the entire scalp, which is observed in some severe acute infectious diseases.
With mixed alopecia, a combination of the two forms of the disease described above is observed.
Hair on the eyebrows falls out in the form of small patches of baldness (omnibus syphilide).
Eyelashes fall out and grow unevenly, resulting in unequal lengths (stepped eyelashes, Pincus sign).
Syphilitic alopecia should be distinguished from alopecia areata, superficial trichophytosis, microsporia, favus, early baldness, lupus erythematosus, and lichen planus.
Rice. 3. Small focal syphilitic alopecia is a sign of secondary syphilis.
Rice. 4. Syphilitic alopecia in men.
Rice. 5. Pincus symptom - stepwise growth of eyelashes with syphilis and hair loss with syphilis on the eyebrows.
Nail damage due to syphilis
- Nails are affected in the second period of syphilis, more often in patients with pustular syphilide. This pathology is rare. The disease affects both the nail itself and the periungual fold.
- Damage to the nail fold begins with the appearance of papules or pustules. They are located isolated on the nail fold, but sometimes merge. The clinical picture resembles panaritium. Papules are red with a bluish tint. The inflammatory reaction is significantly expressed. Sometimes an abscess develops, which ulcerates over time.
- Syphilitic lesions of the nail plate develop slowly. The nail becomes dull and thickens, acquires a grayish-dirty color, and begins to crumble. Transverse and longitudinal cracks appear on it. Sometimes the nail dies completely and is rejected. Even without treatment, a normal nail plate grows back after a few months. Under the influence of specific treatment, a normal nail grows faster.
Damage to the mucous membranes (syphilis in the mouth)
On the mucous membranes of secondary syphilis, syphilitic roseola (spotted syphilide), papular and pustular syphilides are found.
Syphilitic roseola of the mucous membranes
Syphilitic roseola in the oral cavity is isolated, or the spots merge, forming continuous areas of hyperemia in the tonsils (syphilitic tonsillitis) or soft palate. The spots are red, often with a bluish tint, sharply demarcated from the surrounding tissue. The general condition of the patient rarely suffers.
When roseola is localized in the nasal passages, dryness is noted, sometimes crusts appear on the mucous membrane. On the genitals, syphilitic roseola is rare and always inconspicuous.
Papular syphilide of the mucous membranes
The most common type of syphilis is papular syphilide. Papules on the mucous membranes have a dense base and dense consistency, round in shape, smooth, flat, with clear boundaries, deep red in color, and do not bother the patient. Due to constant irritation, their central part macerates and acquires a whitish-gray or yellowish tint. Papillary growths appear on the surface. Papules are prone to hypertrophy. When they merge, fairly large plaques are formed, which have clear boundaries and scalloped edges.
The mucous membrane of the oral cavity, gums, tongue, lips, corners of the mouth, genitals, anus are the main locations of papules. Less commonly, papules are located on the mucous membrane of the pharynx, nose, eyes and vocal cords.
In some cases, in patients with secondary syphilis, erosive-ulcerative syphilide appears on the mucous membranes. Such papules are often located on the tonsils and soft palate.
Papules in the corners of the mouth often become crusty, crack, and resemble jams. Papules on the back of the tongue look like oval, devoid of papillae, bright red formations (“mown meadow symptom”).
Papules may appear on the mucous membrane of the larynx. When the vocal cords are damaged, hoarseness is noted. With a widespread process, complete loss of voice develops (aphonia).
Papular syphilide of the nasal mucosa occurs as a severe catarrhal inflammation.
Papular syphilide of the oral cavity should be distinguished from banal tonsillitis, diphtheria, lichen planus, aphthous stomatitis and planar leukoplakia.
All elements of the rash with syphilis in the oral cavity are extremely contagious. Papular syphilide of the oral cavity poses a great danger to dentists.
Rice. 6. Syphilis in the mouth - papular syphilide of the tongue.
Rice. 7. Syphilis in the mouth - papular syphilide in the corners of the mouth and on the hard palate.
Pustular syphilide of the mucous membranes
Pustular syphilide of the mucous membranes is rare. The development of the disease begins with the appearance of a diffuse infiltrate, which disintegrates over time to form a deep, painful ulcer. The bottom of such an ulcer becomes covered with pus. The process is accompanied by malaise and elevated body temperature.
All erosive and ulcerative processes localized on the mucous membranes should be examined for the presence of Treponema pallidum.
Secondary syphilis
Secondary syphilis
The secondary period of syphilis is characterized by a variety of morphological elements that are located on the skin and visible mucous membranes, as well as changes in internal organs, the nervous system, and the musculoskeletal system. In this case, the pathological process in the internal organs, as a rule, does not have specific signs and rather refers to the body’s general response to a generalized infection. The common features of rashes of the secondary period are their ubiquitous location, rounded outlines, sharp boundaries, lack of tendency to peripheral growth and fusion, copper-red color, and the absence, as a rule, of subjective sensations. Polymorphism of the eruptive elements (the simultaneous appearance of various syphilis), their benign quality (do not destroy tissue, do not leave scars, except in cases of malignant syphilis), and rapid disappearance under the influence of anti-syphilitic treatment are noted. On the erosive surface of secondary syphilides there are a large number of pale treponema, and therefore they are very contagious. Serological tests for syphilis are positive. The most common form of skin lesions in the secondary period of syphilis are: roseola, papules, and much less often - vesicles and pustules. In addition, patients experience pigmentary syphilide (syphilitic leucoderma) and syphilitic hair loss.
Roseola (spotted syphilide) are pink-red, round, non-merging spots up to 1 cm in size with a smooth surface. They are most often located on the lateral surfaces of the torso, chest, abdomen, and upper limbs. The skin of the face, hands, and feet is affected extremely rarely; no subjective sensations are noted. Having existed without treatment for an average of 3-4 weeks, roseola gradually disappears. In addition to the typical roseola, there are extremely rare varieties. Thus, roseola can rise above the surrounding skin - urticarial (syn.: nettle, exudative roseola) and be accompanied by itching. There is also flaky roseola, on the surface of which lamellar scales appear, resembling crumpled tissue paper, and the center appears somewhat sunken. Sometimes, with a very large number of rashes, roseola can merge (confluent roseola) with the formation of continuous erythematous areas. Granular roseola has been described in people suffering from both syphilis and tuberculosis, and hemorrhagic roseola in patients with increased permeability of the vascular walls.
Papular syphilide is a common manifestation of the secondary, especially recurrent, period of syphilis. Based on size, there are large-papular, or lenticular, and small-papular, or miliary, syphilides. Lenticular papules have a round outline, hemispherical shape, sharp boundaries, a size of 0.3-0.5 cm, and are not prone to peripheral growth and fusion. The color of the papules is initially pink, later becoming copper-red or bluish-red (ham). The surface of the papules is smooth and shiny in the first days, and then begins to peel off. The scales in the center of the papules disappear earlier than on the periphery, which causes peeling along the edges in the form of a “Biette collar”. Miliary papules are located around the mouths of hair follicles and are found in weakened patients. Papules exist for 6-8 weeks, leaving behind long-lasting pigmentation. Large papules measuring 1^-2 cm are called coin-shaped. Under the influence of friction and maceration, papules located in the skin folds of the perianal area and genital organs may increase (hypertrophic papules). When they merge, plaque-like papules, or so-called condylomas lata, are formed. As a result of friction, these papules often erode (erosive papules) and begin to become weeping (wetting papules). Papular syphilide of the palms and soles (palpal-plantar syphilide) has a very peculiar appearance. Papules almost do not rise above the general level of the skin, but look like sharply limited reddish-violet or yellowish spots with a dense infiltrate at the base, covered with clusters of dense horny scales. Sometimes these rashes merge and form plaques of varying sizes, on the surface of which there are dense horny masses. When papules are located in the area of the scalp, forehead, nasolabial folds, mainly in patients suffering from oily seborrhea, syphilides are covered with yellowish or gray-yellow fatty scales (seborrheic papules). Psoriasiform syphilide is characterized by a large number of silvery-white lamellar scales on the surface of the papules, making these elements look like psoriatic rashes.
Pustular syphilide is much less common than roseola or papules. It develops in weakened patients suffering from alcoholism, tuberculosis, drug addiction, hypovitaminosis, etc. The following clinical varieties of pustular syphilide are distinguished: superficial - acne-like, smallpox-like, impetigo-like and deep - ecthy-like, rupioid. Acne syphilide is follicular papules, at the top of which there is a pustule with a diameter of 0.2-0.3. cm cone-shaped. The purulent exudate dries quite quickly into a yellowish-brown crust, upon the fall of which you can see barely noticeable depressed pigmented scars. Clinically, it resembles acne vulgaris, differing from the latter in the less acute severity of inflammation. Smallpox syphilide is hemispherical pustules the size of a lentil or pea with an umbilical depression in the center, surrounded by a copper-red infiltrate. The number of elements is often small (10-20), the process lasts a long time (5-7 weeks), usually leaving no scars. In syphilitic impetigo, a pustule forms in the center of the papule and quickly dries out, forming massive, raised layered crusts of yellowish-brown color, surrounded by a dark red infiltrated corolla. The size of the elements is often up to 1 cm, rarely larger, and lasts several months. Syphilitic ecthyma (syn.: ecthyma-like syphilide) is a rare, severe manifestation of pustular syphilide. It is located more often on the legs, less often on the torso and scalp. The number of elements is usually small (up to 10), appearing no earlier than 5-6 months. after infection. Clinically, a deep pustule is formed, covered with a thick grayish-brown crust, which seems to be pressed into the skin. Under the crust there is a deep ulcer, surrounded along the periphery by a dense ridge of copper-red infiltrate. After the ecthyma heals, a pigmented scar remains.
Syphilitic rupee is a type of severe ecthyma with a pronounced tendency to spread both in depth and along the periphery, with the formation of a massive brownish-black crust with a diameter of up to 5 cm and a height of up to 2 cm, similar to an oyster shell. Syphilitic rupee is often single, occurs in the 2-3rd year of the disease, and is located mainly on the torso and extensor surface of the limbs.
Syphilitic leukoderma (syn.: pigment syphilide) occurs mainly on the back and side surfaces of the neck, less often in the armpits, and on the side surfaces of the chest. In lesions on a hyperpigmented background, whitish round or oval spots ranging in size from 0.5 to 1.5 cm appear on the skin. Syphilitic leukoderma does not peel off and is not accompanied by subjective sensations. Depending on the difference in color and width of the hyperpigmented zone, three varieties are distinguished: spotted, reticulated (lace) and marbled. In the spotted form, there is a pronounced contrast between hypo- and hyperpigmented areas and wide areas of hyperpigmentation. In the reticular form, thin areas of hyperpigmentation form a mesh-like structure that looks like lace. In marbled leukoderma, the contrast between hypo- and hyperpigmented areas is insignificant. Typically, leukoderma lasts a long time and disappears after 6-12 months, and sometimes after 2-4 years, even with treatment.
Syphilitic alopecia (baldness) can be small focal, diffuse and mixed. With small focal alopecia on the scalp, especially in the area of the temples and the back of the head, patches of rounded baldness appear, 0.5-1.5 cm in size, not merging with each other. Much less often, syphilitic alopecia is observed in the area of the beard, eyebrows and eyelashes. The affected eyelashes, due to partial loss and successive regrowth, have different lengths (“stepped” eyelashes - Pincus sign). With diffuse alopecia, hair falls out all over the head, but more in the temporal areas. Mixed alopecia is a combination of small focal and diffuse alopecia. The skin in the lesions with syphilitic baldness does not change. Without treatment, hair loss can persist for several months.
Damage to the mucous membranes of the mouth and larynx is often observed in secondary syphilis, and in secondary recurrent syphilis, rashes on the mucous membranes may be the only clinical manifestation of the disease. Almost half of patients with manifestations of secondary syphilis have lesions of the oral mucosa in the form of roseola or papular syphilides. Pustular rashes on the oral mucosa are extremely rare. Syphilides on the oral mucosa are of great epidemiological importance due to their high contagiousness, as they contain a large number of pale treponema. In addition, they often do not cause any sensation, are visible to patients and often cause direct or indirect infection. Spotted syphilide, or roseola, appears symmetrically on the arches, soft palate, uvula, tonsils in the form of individual, 0.5-1 cm or more in size, stagnant red spots of round or oval shape with clear boundaries. In 47-55% of patients, roseolous rashes in this area merge into continuous lesions of congestive red, sometimes with a copper tint, color, smooth surface and sharp boundaries - syphilitic erythematous tonsillitis. The mucous membrane of the pharynx is slightly swollen. Subjective sensations are often absent, but there may be awkwardness or slight pain when swallowing. With secondary syphilis, spotted syphilides in the mouth are combined with roseolous and papular rashes on the skin, specific polyadenitis, and regional scleradenitis. Most often, with secondary syphilis, papular syphilides are found on the mucous membranes. Papules appear on the tongue, the mucous membrane of the cheeks, especially along the line of closure of the teeth, gums, but most often appear on the tonsils, arches, and soft palate. In 10-15% of patients, papules can merge into continuous lesions (papular syphilitic tonsillitis). The papule is a round or oval lesion up to 1 cm in diameter, dark red in color, sometimes with a cyanotic tint, a smooth smooth surface and a slight compaction at the base. Subsequently, the exudate formed as a result of inflammation permeates the epithelium covering the papule, and it acquires a grayish-white color with a narrow inflammatory rim along the periphery, which is sharply demarcated from the surrounding normal mucous membrane (“opal plaques”). Papules may hardly protrude above the surrounding mucous membrane.
When scraped with a spatula, the plaque covering the papule is removed and a meat-red erosion is exposed. After 1-3 weeks. after appearance, the surface of the papules is eroded due to trauma by food, tobacco smoke, etc. Erosive papules are slightly painful and extremely contagious. Sometimes papules on the mucous membrane can ulcerate to form small ulcers covered with a yellowish-gray coating or ignous. When a secondary infection occurs, significant pain appears and the zone of hyperemia around the ulcers expands. Papular elements in the mouth are often focally located, but due to constant trauma they tend to increase peripherally, hypertrophy and merge into plaques that rise above the surrounding tissues. This often occurs when they are located in the corners of the mouth, in transitional folds, on the mucous membrane of the cheeks along the line of closure of the teeth, on the lateral surface of the tongue. Such papules have a pronounced infiltrate, their surface is gray or dirty yellow, and sometimes completely white, reminiscent of diphtheria plaque. The surface of the hypertrophic papule is uneven, granular or cracked. The edges of these papules can be flat or rise quite vertically; the surrounding mucosa can be normal, but also slightly or significantly inflamed, hyperemic, or edematous. Such papules often erode or ulcerate. Pustular syphilitic lesions of the mucous membranes, which later acquire an ulcerative nature, are rare in secondary syphilis and are usually a manifestation of the malignant course of the disease.
Pustular-ulcerative syphilides are often characterized by single, deep, varied painful elements. Their edges are undermined, steep, the bottom is pitted or smooth, covered with purulent discharge. Clinical diagnosis of the specificity of pustular-ulcerative syphilides of the mucous membranes is often difficult. Syphilides located on the back of the tongue are often significantly different from other syphilides of the oral mucosa. In some cases, the filiform papillae of the tongue in the area of the papules are clearly defined, and then the papule protrudes above the level of the mucous membrane in the form of uneven gray foci. However, more often there are no papillae in the area of the rash. In this case, the papules have a polished smooth shiny surface, pinkish-bluish color, irregular or oval shape. Such syphilides existing among the normal or lightly coated mucous membrane of the tongue create the impression that the affected areas are located just below the level of the surrounding tissues (“glossy” papules, “mown meadow” plaques, “alopecia of the tongue”). Papular lesions of the dorsum of the tongue with folded glossitis have a peculiar appearance. Papules are located in the area of the ridges of existing folds, the grooves of the tongue deepen significantly, their edges become denser, and can become V-shaped, perceived as deep cracks. The most common location of syphilitic papules in the mouth is the tonsils, the lesions of which are commonly called papular syphilitic tonsillitis. The clinical picture is very diverse and depends on the location, type and number of rashes. Papules can be located directly at the mouths of the lacunae in the form of whitish overlays, resembling a nonspecific sore throat. Papules often appear along the edge of the anterior arches and then spread to the tonsils, and upward in an arched manner they pass to the soft palate and often reach the hard palate. It is the localization of papules on the arches that distinguishes syphilitic papular tonsillitis from lacunar tonsillitis.
Papules can be located in the fold between the anterior palatine arch and the tonsil or only on the posterior surface of the velum, where they can be detected using a nasopharyngeal speculum during posterior rhinoscopy or when retracting the anterior arch with a spatula. With secondary syphilis, damage to the larynx may be observed, the main symptom of which is prolonged, almost painless hoarseness, reaching aphonia, not accompanied by general colds. Most patients have a catarrhal form of laryngeal lesions, less often papular.
Syphilitic sore throat
Syphilitic sore throat is one of the manifestations of syphilis in the mouth. With syphilitic roseola, spots appear in the area of the tonsils and lymphoid ring, which can be located either isolated or merge, forming continuous areas of hyperemia (syphilitic tonsillitis). The spots are red, often with a bluish tint, sharply demarcated from the surrounding tissue. The general condition of the patient rarely suffers.
With secondary syphilis, papular tonsillitis is more common. Papular elements tend to grow peripherally and often merge, forming plaques with clear boundaries. When ulcerated, the papules become covered with a whitish coating. When the mucous membrane of the pharynx is affected, there is pain when swallowing. Ulcerated papules are always accompanied by pain. The patient's general condition worsens. An increased body temperature appears.
Rice. 8. Syphilis in the mouth - syphilitic sore throat: syphilitic roseola (photo on the left) and papular syphilide (photo on the right).
Rice. 9. Syphilis in the mouth - syphilitic sore throat.
Signs of syphilitic lesions of the mucous membranes of the nose and oral cavity, pharynx and larynx:
- the disease proceeds without pronounced inflammatory phenomena,
- painlessness,
- the course of the disease is long,
- resistance to anti-inflammatory traditional therapy is noted,
- tests for syphilis are often positive.
Papular syphilide
Papular syphilide is a dermal papule that is formed as a result of an accumulation of cells (cellular infiltrate) located under the epidermis in the upper dermis. The elements of the rash have a round shape, are always clearly demarcated from the surrounding tissues, and have a dense consistency. Their main locations are the trunk, limbs, face, scalp, palms and soles, oral mucosa and genitals.
- The surface of the papules is smooth, shiny, and smooth.
- The color is pale pink, copper or bluish red.
- The shape of the papules is hemispherical, sometimes pointed.
- They are located in isolation. Papules located in skin folds tend to grow peripherally and often merge. Vegetation and hypertrophy of papules leads to the formation of condylomas lata.
- With peripheral growth, the resorption of papules begins from the center, resulting in the formation of various figures.
- Papules located in the folds of the skin sometimes erode and ulcerate.
- Depending on the size, miliary, lenticular and coin-shaped papules are distinguished.
Papular syphilides are extremely contagious, as they contain a huge number of pathogens. Particularly contagious are patients whose papules are located in the mouth, perineum and genitals. Handshakes, kisses and close contact can cause transmission of infection.
Papular syphilides resolve within 1 to 3 months. When the papules dissolve, peeling is observed. Initially, it appears in the center, then, like a “Biette collar,” on the periphery. In place of the papules, a pigmented brown spot remains.
Papular syphilide is more typical for recurrent secondary syphilis.
Rice. 5. Rash due to secondary syphilis - papular syphilide.
Miliary papular syphilide
Miliary papular syphilide is characterized by the appearance of small dermal papules - 1 - 2 mm in diameter. Such papules are located at the mouths of the follicles; they are round or cone-shaped, dense, covered with scales, sometimes with horny spines. The trunk and limbs are their main places of localization. Resolution of papules occurs slowly. A scar remains in their place.
Miliary papular syphilide should be distinguished from lichen scrofulous and trichophytosis.
Miliary syphilide is a rare manifestation of secondary syphilis.
Lenticular papular syphilide
Lenticular papules form in the 2nd to 3rd year of the disease. This is the most common type of papular syphilis, occurring in both early and late secondary syphilis.
The size of the papules is 0.3 - 0.5 cm in diameter, they are smooth and shiny, round in shape with a truncated apex, have clear contours, pink-red color, and are painful when pressed with a button probe. As the papules develop, they become yellowish-brown in color, flatten, and become covered with transparent scales. A marginal appearance of peeling (“Biette’s collar”) is characteristic.
During early syphilis, lenticular papules can appear on different parts of the body, but most often they appear on the face, palms and soles. During the period of recurrent syphilis, the number of papules is smaller, they tend to group, and bizarre patterns are formed - garlands, rings and arcs.
Lenticular papular syphilide should be distinguished from guttate parapsoriasis, lichen planus, vulgar psoriasis, and papulonecrotic tuberculosis of the skin.
On the palms and soles, papules are reddish in color with a pronounced cyanotic tint, without clear boundaries. Over time, the papules acquire a yellowish color and begin to peel off. A marginal appearance of peeling (“Biette’s collar”) is characteristic.
Sometimes the papules take on the appearance of calluses (horny papules).
Palmar and plantar syphilides should be distinguished from eczema, athlete's foot and psoriasis.
Lenticular papular syphilide occurs in both early and late secondary syphilis.
Rice. 6. Lenticular papules in secondary syphilis.
Rice. 7. Palmar syphilide with secondary syphilis.
Rice. 8. Plantar syphilide with secondary syphilis
Rice. 9. Secondary syphilis. Papules on the scalp.
Coin-shaped papular syphilide
Coin-shaped papules appear in patients during the period of recurrent syphilis, in small quantities, bluish-red in color, have a hemispherical shape, measuring 2 - 2.5 cm in diameter, but can be larger. When resorption occurs, pigmentation or an atrophic scar remains in place of the papules. Sometimes there are many small ones around the coin-shaped papule (bursant syphilide). Sometimes the papule is located inside a ring-shaped infiltrate; between it and the infiltrate there remains a strip of normal skin (a type of cockade). When coin-shaped papules coalesce, plaque syphilide is formed.
Rice. 10. A sign of syphilis of the secondary period is psoriasiform syphilide (photo on the left) and nummular (coin-shaped) syphilide (photo on the right).
Wide type of papular syphilide
The broad type of papular syphilide is characterized by the appearance of large papules. Their size sometimes reaches 6 cm. They are sharply demarcated from healthy areas of the skin, covered with a thick stratum corneum, and dotted with cracks. They are a sign of recurrent syphilis.
Seborrheic papular syphilide
Seborrheic papular syphilide often appears in places with increased sebum secretion - on the forehead (“the crown of Venus”). On the surface of the papules there are fatty scales.
Rice. 11. Seborrheic papules on the forehead.
Weeping papular syphilide
Weeping syphilide appears in areas of the skin where there is increased humidity and sweating - the anus, interdigital spaces, genitals, large folds of skin. Papules in these places undergo maceration, become wet, and acquire a whitish color. They are the most contagious form among all secondary syphilides.
Weeping syphilide must be distinguished from folliculitis, contagious molluscum, hemorrhoids, chancroid, pemphigus and epidermophytosis.
Rice. 12. Secondary syphilis. Weeping and erosive papules, condylomas lata.
Erosive and ulcerative papules
Erosive papules develop in the event of prolonged irritation of their localization sites. When a secondary infection occurs, ulcerative papules are formed. The perineum and anal area are common places for their localization.
Condylomas lata
Papules that are subject to constant friction and weeping (anal area, perineum, genitals, inguinal, less often axillary folds) sometimes hypertrophy (increase in size), vegetate (grow) and turn into condylomas lata. Vaginal discharge contributes to the appearance of condylomas.
Rice. 13. When papules grow, condylomas lata are formed.
Damage to internal organs, bones, joints and nervous system
Damage to internal organs
With early secondary syphilis, any organs can be affected, but the liver and stomach most often become inflamed, myocarditis and nephrosonephritis develop. The inflammatory process often does not manifest itself clinically.
Damage to the osteoarticular apparatus
Bones and joints are affected at the end of the primary period of syphilis, but more often lesions are recorded in the secondary period. Pain is the main symptom of the disease. There is pain in the lower extremities in the area of long tubular bones, knee and shoulder joints. Hydroarthrosis, periostitis and osteoperiostitis occur.
