Rash due to secondary syphilis
Secondary syphilis is characterized by the appearance of a rash on the skin and mucous membranes - secondary syphilides. The rash with secondary fresh syphilis is abundant and varied (polymorphic): spotted, papular, vesicular and pustular. The rash can appear on any part of the skin and mucous membranes.
- The most abundant rash at the first rash, often symmetrical, the elements of the rash are small in size, always brightly colored. Often against its background one can detect residual signs of primary syphiloma (chancre), regional lymphadenitis and polyadenitis.
- Secondary recurrent syphilis is characterized by less profuse rashes. They are often grouped to form fancy patterns in the form of garlands, rings and arcs.
- The number of rashes in each subsequent relapse becomes less and less. At the end of the second stage of syphilis, monorelapses occur, when the clinical picture is limited to a single element.
Elements of the rash in secondary syphilis have some features: high prevalence at the beginning of the secondary period, sudden appearance, polymorphism, clear boundaries, peculiar coloring, lack of reaction of surrounding tissues, peripheral growth and subjective sensations, benign course (often the rash disappears spontaneously without scarring and atrophy), high contagiousness of the elements of the rash.
Rice. 2. Manifestations of secondary syphilis - syphilitic seizure.
Damage to the lower leg areas (saber shins)
The pathology typically manifests itself in the child’s infancy.
It accounts for 70% of all pathologies associated with late syphilitic manifestations.
A large proportion of the damage occurs in the periosteum and tibia - osteoperiostitis, osteochondritis (damage to the cartilage itself involving a small area of the bone itself),
Due to the weight of the child, the bones simply bend forward.
The child grows and learns to walk, his legs resemble a saber blade.
The bones become thicker and longer.
At the same time, the child begins to sleep restlessly, as he is bothered by night pain in his legs.
In this case, damage to the bones of the forearm is not observed.
To confirm this diagnosis, an x-ray examination is necessary.
In addition to the saber-shaped manifestation of syphilis, there is a similar symptom with Paget's disease or rickets, when the bones bend outward.
Syphilitic roseola
Syphilitic roseola of the skin
Syphilitic roseola (spotted syphilide) is the most common form of damage to the mucous membranes and skin in early secondary syphilis. It accounts for up to 80% of all rashes. Syphilitic roseola is spots from 3 to 12 mm in diameter, from pink to dark red in color, oval or round in shape, do not rise above the surrounding tissues, there is no perifocal growth and peeling, the spots disappear with pressure, there is no pain and itching.
Roseola is caused by vascular disorders. In the dilated vessels, over time, the breakdown of red blood cells occurs with the subsequent formation of hemosiderin, which causes the yellowish-brown color of old spots. Roseolas that rise above the skin level often peel off.
The main locations for roseola are the trunk, chest, limbs, abdomen (often the palms and soles) and sometimes the forehead. Roseola are often located on the mucous membrane of the oral cavity, rarely on the genitals, where they are hardly noticeable.
Elevated, papular, exudative, follicular, confluent - the main forms of spotted syphilide. With relapses of the disease, the rash is more sparse, less colored, and tends to group with the formation of arcs and rings.
Spotted syphilide should be distinguished from pubic lice bites, pityriasis versicolor and pityriasis versicolor, infectious roseola, measles, rubella and tartaric skin.
Rice. 2. Rash due to secondary syphilis - syphilitic roseola.
Rice. 3. Signs of secondary syphilis - syphilitic roseola on the skin of the body.
Syphilitic roseola of the mucous membranes
Syphilitic roseola in the oral cavity is located isolated, sometimes 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 localized on the mucous membrane of the nasal passages, dryness is noted, and crusts sometimes appear on the surface. On the genitals, syphilitic roseola is rare and always inconspicuous.
Rice. 4. Syphilitic roseola in the oral cavity - erythematous sore throat.
Syphilitic roseola is a typical manifestation of early secondary syphilis.
Diagnostics
To prevent the diagnosis of syphilis from showing a false positive or false negative result, it is necessary to do this only with the help of modern tests in a laboratory that has all the necessary equipment and reagents:
- Determination of antibodies to Treponema pallidum in the passive hemagglutination reaction (PHA) in the blood is one of the most popular methods for diagnosing both primary and secondary or tertiary syphilis. Used to confirm or refute the diagnosis at any stage of the disease.
- Determination of antibodies to Treponema pallidum in the blood using the ICL method is used for screening diagnosis of the disease before hospitalization, during a medical examination and obtaining medical certificates, as well as for the primary diagnosis of the disease in the presence of chancroid.
- Determination of class M antibodies (lgM) to Treponema pallidum using the enzyme immunoassay method (ELISA) in the blood allows one to determine the presence of the disease with a 100% result.
- Syphilis in men can be diagnosed by determining the DNA of the pathogen in urethral discharge using the PCR method. Also scraping of epithelial cells is carried out in women, but here it can be the cervical canal or discharge from the vagina.
- Determination of antibodies to Treponema pallidum in non-treponema tests (RPR, RMP) in the blood allows you to determine primary, secondary or tertiary syphilis, but it is recommended to use specific tests to confirm the diagnosis.
- Determination of Treponema pallidum DNA in blood, biological fluids, secretions from mucous membranes (except genitals), cerebrospinal fluid and effusion using the PCR method is done in the presence of such a clear symptom as chancroid, as well as during pregnancy. The test is recommended to be taken during treatment to monitor the effect of prescribed medications.
- Prescribing and monitoring the course of treatment for sexually transmitted diseases and sexually transmitted diseases.
An analysis for syphilis should be done during the primary period no earlier than 2 weeks from the moment of infection.
Until then, even the most sensitive test will show a negative result. The fact is that primary syphilis is divided into two periods - seronegative, when it cannot be detected, and seropositive, in which the disease can already be diagnosed. Specific serological reactions in people who have recovered from the disease will always be positive. Therefore, they are not used to monitor the effectiveness of prescribed therapy.
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.
Vesicular syphilide
Vesicular syphilide occurs in severe syphilis. The main places of localization of syphilides are the skin of the extremities and torso. On the surface of the formed plaque, which is red in color, many grouped small vesicles (bubbles) with transparent contents appear. The vesicles quickly burst. In their place, small erosions appear, and when they dry, crusts form on the surface of the rash. When cured, a pigment spot with many small scars remains at the site of the lesion.
The rashes are resistant to therapy. With subsequent relapses they appear again. Vesicular syphilide should be distinguished from toxicerma, simple and acute herpes.
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.
Dystrophies (stigmas)
The occurrence of a number of dystrophies in congenital syphilis is not associated with exposure to Treponema pallidum (the causative agent of syphilis) and does not have any diagnostic value. They develop with many infectious diseases and intoxications, for example, with parental alcoholism. Stigmas can indicate that a child may be affected by syphilis and help in making a diagnosis.
Rice. 16. Enlarged and protruding frontal and parietal tubercles without a dividing groove (“Olympic forehead”). The anomaly occurs in 36% of patients.
Rice. 17. A high hard palate (“lancet” or “Gothic”) occurs in 7% of cases.
Rice. 18. Diastema (distance, gap) between the central incisors. Most often found on the upper jaw.
Rice. 19. A thickened sternal end (usually the right) of the clavicle (Ausitidian-Igumenakis symptom) occurs in patients with congenital syphilis in 25% of cases. The cause of the pathology is hyperostosis. In 13 - 20% of cases with congenital syphilis, there is an absence of the xiphoid process (Queir's axiphodia).
Rice. 20. A shortened (infantile) little finger (Dubois symptom) is recorded in 12% of cases with congenital syphilis. The little finger may be curved and turned towards the other fingers (Hissar's symptom).
Rice. 21. Stigmas indicating congenital syphilis may include spider fingers—abnormally long and narrow fingers (arachnodactyly).
Rice. 22. Girls and boys with congenital syphilis may experience hypertrichosis - growth of hair on the forehead (Tarkovsky hypertrichosis).
