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Papulosquamous rash over trunk and chest
Last reviewed: December 2022
Author: Dr Ian Coulson, Consultant Dermatologist and Editor-in-Chief, 2022.
Edited by the DermNet content department
Background
This sixty-five-year-old man with no past history of skin disease has developed a papulosquamous rash over his trunk and chest in the last 6 weeks. He has been feeling out of sorts, and he has developed some axillary and groin lymphadenopathy. As well as the rash on his trunk, he has these lesions on the soles of both feet.
What is the most likely diagnosis?
A papulosquamous eruption with lesions on the palms and soles should always raise suspicion of secondary syphilis. This should initiate questioning regarding sexual contacts, and recent history of genital, oral, or perianal primary syphilis lesions (chancres).
What else should you look for?
What investigations are required?
The VDRL test will always be positive in secondary syphilis unless there is co-infection with HIV. Treponema pallidum PCR testing may be positive from mucosal lesions.
How should he be managed?
Referral to STD services is mandatory to both contact trace and identify co-infection with other sexually transmitted diseases. The syphilis infection will be treated with intramuscular penicillin according to local guidelines.