Exclusive palmoplantar maculopatchy lesions in a patient of secondary syphilis

Abstract

Syphilis, sexually transmitted disease which is caused by spirochete bacterium, Treponema pallidum. It presents with a spectrum of lesions and the signs and symptoms of syphilis vary depending on which of the four stages it presents. One needs a high level of clinical suspicion and keen history taking are required to identify the underlying syphilis, which is very commonly masked as some other cutaneous condition. Many different skin diseases may have lesions with a annular maculo-papular erythematous morphology and scaling, e.g., pityriasis rosea of Gibert, actinic porokeratosis, erythema annulare centrifugum, granuloma annulare, subacute or discoid lupus erythematosus and certain annular variants of psoriasis. Some of these also have palmo-plantar involvement where these need to be differentiated from from the rash of secondary syphilis. The present article addresses a case of solely palmoplantar hyperpigmented lesion without any clinical evidence of secondary syphilis.