Clinicopathological, dermoscopic, and ultrastructural observation of annular secondary syphilis on the penis

Abstract

Annular syphilis may range from mildly raised lesions with scaly borders to verrucous plaques. Localized annular syphilis on the genitalia has been rarely reported in HIV-negative cases. This paper reports a case of annular secondary syphilis on the penis. Dermoscopy showed peripheral dotted and short linear vessels and white scaling with a relatively clear central area in an erythematous annular plaque. Histopathology revealed mild hyperkeratosis, parakeratosis, psoriasiform acanthosis, and focal basal vacuolar degeneration with lichenoid, perivascular, and periadnexal infiltrate of lymphohistiocytes and plasma cells in the superficial dermis. Silver stain showed several spirochetes in the lower epidermis and superficial dermis. Electron microscopy revealed a few intercellular and intracytoplasmic spirochetes in the basal epidermis and free spirochetes in the papillary dermis. Rapid plasma reagin and Treponema pallidum particle agglutination assays were positive. The lesions disappeared after intramuscular benzathine penicillin, with no relapse at six-month follow-up.

Dermoscopy of Bacterial, Viral, and Fungal Skin Infections: A Systematic Review of the Literature

“…Finally, nonspecific vascular findings (dotted, short-linear, linear-irregular, and hairpin vessels) along with white scales were observed in a single instance of penile annular syphiloderm [ 27 , 28 ].…”

Clinicodermoscopic observation of secondary recurrent syphilis with annular scaly lesions on the penis

“…Genital annular syphilis is uncommon, and needs to distinguish from granuloma annulare, annular lichen planus, annular psoriasis, scabies, and dermatophytosis. 2 Biett's sign and orangish background are typical dermoscopic features of extragenital syphilis, [5][6][7] but they are missing in penoscrotal annular syphilis. 2,8 In this case, orangish background rather than Biett's sign was present at the inner margin of the raised border in annular plaques.…”

“…2 Biett's sign and orangish background are typical dermoscopic features of extragenital syphilis, [5][6][7] but they are missing in penoscrotal annular syphilis. 2,8 In this case, orangish background rather than Biett's sign was present at the inner margin of the raised border in annular plaques. Although orangish background may correspond to dermal hemosiderin deposition, 5 our pathological results showed no hemosiderin deposit and erythrocyte extravasation in the dermis.…”

“…Brodalumab is a recombinant, fully human, anti-interleukin-17 receptor A, monoclonal antibody, exhibiting long-term efficacy in plaque psoriasis, due to the concurrent inhibition of proinflammatory cytokines IL-17A, IL-17C, IL-17E, IL-17F and IL-17A/F heterodimer. 1,2 The objective of this open-label, unblinded study was to evaluate its efficacy in nail psoriasis as assessed by the Nail Psoriasis Severity Index (NAPSI) and the Dermatology Life Quality Index (DLQI).…”

“…However, dermoscopic features of secondary syphilis on genital area have been omitted in the section 'Infectious diseases'. In addition to the dermoscopic observation of annular secondary syphilis on the penis, 2 we have recently encountered another case of secondary recurrent syphilis with localized annular lesions on the penis. These observations could enlarge the dermoscopic feasibility in the dermatological practice.…”