Lichenoid secondary syphilis

Lochner, J. C.

doi:10.1001/archderm.109.1.81

Cited by 7 publications

(3 citation statements)

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“…Hair loss can also occur (moth-eaten alopecia/alopecia syphilitica), typically affecting the scalp, but also the eyebrows or total body hair loss. Secondary syphilis has been termed the “great masquerader”, because its skin lesions show such diverse clinical and/or histologic morphologies, mimicking alopecia areata (130), bullous pemphigoid (131), cutaneous lymphoid hyperplasia (pseudolymphoma) (132–135), erythema multiforme (126, 136), granuloma annulare (43, 128, 137, 138), histiocytoma (34), leprosy (128, 139, 140), lichen planus (34, 126, 135, 141, 142), lupus erythematosus (43, 128, 143), mycosis fungoides (126, 144–146), pemphigus vulgaris (147), pityriasis lichenoides et varioliformis acuta (PLEVA) (34, 126, 135), pruritic (eczematous) dermatoses (126, 128, 148), psoriasis (34, 128, 149, 150), pustular psoriasis (34, 128), sarcoidosis (34, 135, 151–155), small vessel vasculitis (156), suppurative folliculitis (157), superficial thrombophlebitis (158), Sweet’s syndrome (128, 159), tinea imbricata and erythema annulare centrifugum (34, 160), and urticaria (104). Ulcerative nodular presentations are rare and can occur secondary to follicular pustules (157, 161), or an obliterative endarteritis, known as lues maligna (162, 163).…”

Section: The Pathology Of Human Syphilismentioning

confidence: 99%

The Immunopathobiology of Syphilis: The Manifestations and Course of Syphilis Are Determined by the Level of Delayed-Type Hypersensitivity

Carlson

Dabiri²,

Cribier³

et al. 2011

The American Journal of Dermatopathology

158

136

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Syphilis has plagued mankind for centuries and is currently resurgent in the Western hemisphere. While there has been a significant reduction of tertiary disease, and recognition of facilitative interactions with HIV infection, the natural history of syphilis has remained largely unchanged; thus, new strategies are required to more effectively combat this pathogen. The immunopathologic features of experimental syphilis in the rabbit; the course, stages, and pathology of human syphilis; and a comparison of human syphilis with leprosy suggest that the clinical course of syphilis and its tissue manifestations are determined by the balance between delayed type hypersensitivity (DTH) and humoral immunity to the causative agent, Treponema pallidum. A strong DTH response is associated with clearance of the infecting organisms in a well-developed chancre, whereas a cytotoxic T-cell response or strong humoral antibody response is associated with prolonged infection and progression to tertiary disease. Many of the protean symptoms/appearances of secondary and tertiary human syphilis are manifestations of immune reactions that fail to clear the organism, due to a lack of recruitment and more importantly, activation of macrophages by sensitized CD4 T-cells. The Bacillus Calmette Guerin (BCG) vaccination can enhance DTH and has been shown to produce a low, but measurable beneficial effect in the prevention of leprosy, a disease that shows a disease spectrum with characteristics in common with syphilis. In the prevention of syphilis, a potential vaccine protective against syphilis should be designed to augment the DTH response.

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Section: The Pathology Of Human Syphilismentioning

confidence: 99%

The Immunopathobiology of Syphilis: The Manifestations and Course of Syphilis Are Determined by the Level of Delayed-Type Hypersensitivity

Carlson

Dabiri²,

Cribier³

et al. 2011

The American Journal of Dermatopathology

158

136

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“…[6] In 1974, Lochner and Pomeranz established the clinical-histopathologic correlation for lichenoid lesions occurring in syphilis. [7]…”

Section: Discussionmentioning

confidence: 99%

“…[891011] Most of these cases including the present case had associated pruritus, which is otherwise an unusual symptom in S2 per se . [71011] Annular lichenoid lesions are even rare and have been reported previously on only two occasions. [1011] The localized annular lichenoid lesions may present as a diagnostic dilemma, more so when other features of secondary syphilis are absent, as seen on the first visit in the present case.…”

Section: Discussionmentioning

confidence: 99%

Annular lichenoid syphilis: A rare entity

Khurana

Singal

Gupta

2014

Indian J Sex Transm Dis

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Lichenoid secondary syphilis

et al. 1999

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Argentina Case 1 A married, heterosexual, promiscuous, 29‐year‐old white man had experienced an asymptomatic eruption on the trunk and left palm for the last 3 months. After 2 months, the trunk involvement disappeared, but 2 weeks later lip and tongue lesions developed. No history of genital ulcer was found. The physical examination revealed asymptomatic, violaceous, erythematous, flat‐topped papules in an annular pattern, 5–10 mm in size, on the left palm (Fig. 1). Painful vesicular lesions surrounded by a red halo, with erosions on the labial mucosa and defined areas of depapillation on the posterior aspect of the tongue, were observed. The genitalia and soles were free of lesions. The clinical findings suggested lichen planus or secondary syphilis. 1 Flat‐topped papules on the palm A biopsy specimen of the palm was consistent with a lichenoid dermatitis, with hyperkeratosis, parakeratosis, acanthosis, striking elongation of the rete ridges, leukocytic exocytosis, and sparse colloid bodies. A band‐like dense lymphomonocytic infiltrate without plasma cells was present throughout the papillary dermis. The infiltrate obscured the dermo‐epidermal interface (Fig. 2). A lip biopsy showed a subacute inflammatory dermatitis. Venereal Disease Research Laboratory (VDRL) titers were high (1/1024) and fluorescent treponemal antibody absorbed (FTA‐ABS) test was positive. Enzyme‐linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) was negative. After two weekly doses of benzathine penicillin G (2.4 million units), all lesions cleared within 3 weeks. 2 Parakeratosis and acanthosis with thinning of the rete ridges. Lichenoid infiltrates of lymphocytes and monocytes (hematoxylin and eosin; original magnification ×40) Case 2 A 42‐year‐old white man had developed cutaneous lesions involving the trunk and extremities over the past 2 weeks. Anorexia, malaise, and generalized arthralgia were also noted. He was married and denied casual sexual partners. Itching, erythematous, flat‐topped papules with scaling and some crusts on the trunk and extremities were observed (Fig. 3). The palms and soles were free of lesions. The glans penis showed painless, erythematous, shallow erosions. Neck microlymphadenopathy was present. All other physical findings were normal. 3 Lichenoid eruption on the trunk FTA‐ABS and VDRL (1/1024) tests were reactive. ELISA for HIV was negative. The dark field microscopy examination of the glans penis exudate revealed Treponema pallidum with no spiraling motion. A biopsy specimen of the trunk showed a lichenoid dermatitis with increased numbers of perivascular and periadnexial plasma cells, in the superficial and deep dermis (Fig. 4). Two weekly doses of benzathine penicillin G 4 Superficial perivascular dermatitis; dermo‐epidermal interface lichenoid (hematoxylin and eosin; original magnification ×100) (2.4 million units) were given. All lesions faded in 3 weeks.

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Lichenoid secondary syphilis

Cited by 7 publications

References 0 publications

The Immunopathobiology of Syphilis: The Manifestations and Course of Syphilis Are Determined by the Level of Delayed-Type Hypersensitivity

The Immunopathobiology of Syphilis: The Manifestations and Course of Syphilis Are Determined by the Level of Delayed-Type Hypersensitivity

Annular lichenoid syphilis: A rare entity

Lichenoid secondary syphilis

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