Secondary Syphilis in Tattoos: The Chicken or the Egg?
Tejesh Patel1, Molly Rogers2, Jason Patel1
1Department of Dermatology, University of Tennessee Health Science Center, Memphis, TN; and.
The American Journal of Dermatopathology
|November 12, 2025
Summary
Secondary syphilis can cause granulomatous dermatitis in tattoos, mimicking other conditions. Early diagnosis and penicillin treatment led to complete resolution in two reported cases.
Area of Science:
- Dermatology
- Infectious Diseases
- Pathology
Background:
- Granulomatous dermatitis in tattoos is typically linked to pigment reactions, infections, or sarcoidosis.
- Secondary syphilis is a systemic infection that can manifest in various dermatological forms.
Purpose of the Study:
- To report an uncommon presentation of secondary syphilis as granulomatous dermatitis localized to black tattoo ink.
- To emphasize the importance of considering syphilis in the differential diagnosis of tattoo-associated skin lesions.
Main Methods:
- Case report of two patients with secondary syphilis.
- Histopathological examination of skin biopsies from tattoo sites.
- Special staining to identify spirochetes.
- Clinical follow-up after treatment.
Main Results:
- Both patients presented with granulomatous inflammation exclusively within black tattoo ink.
- Histology revealed granulomatous dermatitis with plasma cells and confirmed the presence of spirochetes.
- Complete resolution of symptoms was achieved with penicillin therapy.
Conclusions:
- Secondary syphilis can present as granulomatous dermatitis confined to tattoo ink.
- Syphilis should be considered in the differential diagnosis of papules and inflammation within tattoos.
- Prompt diagnosis and appropriate antibiotic treatment are crucial for favorable outcomes.
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