Secondary syphilis: a clinico-pathological review

Area of Science:

• Dermatopathology
• Infectious Diseases
• Histology

Background:

• Secondary syphilis presents with diverse cutaneous manifestations.
• Histopathological findings are crucial for diagnosing syphilis but can show variability.

Purpose of the Study:

• To correlate histological patterns in secondary syphilis biopsies with clinical morphology.
• To assess the frequency of classically described histopathological changes.

Main Methods:

• Histological examination of 57 patient biopsies with secondary syphilis.
• Correlation of biopsy findings with clinical presentation of skin eruptions.

Main Results:

• Considerable variation in histological patterns observed.
• Plasma cell infiltration absent/sparse in nearly 25% of biopsies.
• Vascular damage infrequent, primarily endothelial swelling; epidermal changes (exocytosis, spongiosis, parakeratosis, acanthosis) common.
• Macular lesions showed superficial dermal and less severe epidermal involvement.
• Late secondary lesions exhibited granulomatous infiltrate.

Conclusions:

• Histopathological findings in secondary syphilis show significant variability.
• Absence of expected changes like plasma cell infiltration can occur.
• Histopathology remains valuable for diagnosing secondary syphilis, aiding differential diagnosis from other dermatoses.