An annular patch of the scalp reveals tertiary syphilis

Challenges in the Diagnosis of Tertiary Syphilis: Case Report with Literature Review

“…Late symptomatic syphilis is a rare systemic disease that can affect the skin, the mucous membranes, the circulatory system, the nervous system and the skeletal system. The incidence of tertiary syphilis decreases significantly with the introduction of penicillin in its early stage, but new cases of this disease are still being reported [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ,…”

“…Syphilis can be divided into primary and secondary stage early syphilis (within one year of infection), and late latent and symptomatic syphilis [ 10 ]. The number of cases of late symptomatic syphilis have dropped significantly since the implementation of penicillin to treat early syphilis [ 11 ], but occasional cases of tertiary syphilis are still noted [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ,…”

Disorders of Hair

“…A cutaneous manifestation of tertiary syphilis is the formation of gummas, and sharply demarcated necrotic ulcerations that heal with polycyclic scars (Finner et al 2008). Tertiary syphilis on scalp area can be also presented as round alopecic plaque with raised, infiltrated rims (Bekkali et al 2014). • Pathological manifestation: Tertiary syphilis is characterized by the presence of granulomas with multinucleated giant cells, a dense perivascular, and perifollicular infiltrate consisting of lymphocytes and plasma cells that induce vacuolar degeneration with apoptotic cells (Bekkali et al 2014).…”

“…Tertiary syphilis on scalp area can be also presented as round alopecic plaque with raised, infiltrated rims (Bekkali et al 2014). • Pathological manifestation: Tertiary syphilis is characterized by the presence of granulomas with multinucleated giant cells, a dense perivascular, and perifollicular infiltrate consisting of lymphocytes and plasma cells that induce vacuolar degeneration with apoptotic cells (Bekkali et al 2014). • Prognosis and treatment: Carbuncle can be treated with topical and oral antibiotics (Finner et al 2008).…”

“…The treatment of syphilis associated with scarring alopecia is the same as that for systemic disease. • Differential diagnosis: Epidermoid cyst, folliculitis, botryomycosis, and myiasis for carbuncle (Spelman and Baddour 2018), and cutaneous tuberculosis for tertiary syphilis (Bekkali et al 2014).…”