Secondary Syphilis Presenting As Palmoplantar Psoriasis

Abstract

In a recent past, the incidence of syphilis has increased in various geographical regions. The authors describe a case of secondary syphilis mimicking palmoplantar psoriasis.

Psoriasiform syphilis: a challenge

“…9 In modern literature, psoriasiform syphilis has been more frequently reported with presentation mimicking palmoplantar psoriasis, either in patients co-infected with HIV, [8][9][10] or in HIV-negative patients. [11][12][13][14][15] In most cases, syphilis was not correctly diagnosed at the beginning and the patients were treated for psoriasis. 11,12,16 To our knowledge, there is not a clear cut explanation of the pathophysiological mechanism of this type of presentation.…”

“…[11][12][13][14][15] In most cases, syphilis was not correctly diagnosed at the beginning and the patients were treated for psoriasis. 11,12,16 To our knowledge, there is not a clear cut explanation of the pathophysiological mechanism of this type of presentation. 3 A familiar history of psoriasis was also not reported by our patient.…”

Dermoscopic clues in the skin lesions of secondary syphilis

“…Orange background of lesions over palm seen in our patient is consistent with the description by Errichetti and Stinco, who attributed the finding to the deposition of hemosiderin in the dermis due to extravasation of erythrocytes. The secondary lesions of syphilis may be confused with the lesions of papulosquamous disorders like guttate psoriasis, pityriasis rosea, and pityriasis lichenoides chronica . Dermoscopy of guttate psoriasis usually displays dotted vessels distributed uniformly over the lesions while pityriasis lichenoides chronica commonly shows nondotted vessels, focally distributed dotted vessels, and orange‐yellowish structureless areas .…”

“…The secondary lesions of syphilis may be confused with the lesions of papulosquamous disorders like guttate psoriasis, pityriasis rosea, and pityriasis lichenoides chronica. [10][11][12] Dermoscopy of guttate psoriasis usually displays dotted vessels distributed uniformly over the lesions while pityriasis lichenoides chronica commonly shows nondotted vessels, focally distributed dotted vessels, and orange-yellowish structureless areas. 11,12 Pityriasis rosea shows peripheral whitish scaling as well as dotted vessels in an irregular or focal pattern with localized or diffuse yellowish-orange structureless areas.…”

Secondary syphilis presenting as Syphilide psoriasiforme: lessons from the older syphilology literature

“…Solak et al 3 reported the case of a 43-year-old male patient with syphilide psoriasiforme who was misdiagnosed and treated as palmoplantar psoriasis for 2 years. Similarly, Gianfaldoni et al 4 described the case of a 45 year-old male patient who was initially diagnosed and treated as a palmoplantar psoriasis before the correct diagnosis of syphilide psoriasiforme was made.…”