Rash with syphilis: the most typical manifestations, types, methods of diagnosis and treatment

Syphilis refers to severe systemic infections transmitted sexually, through household contact, or by blood transfusion. By and large, the causative agent of the disease, the microorganism pale treponema, is quite sensitive to quite standard antibacterial drugs from the group of penicillins, tetracyclines.

The main thing is to clearly observe the dosage and duration of admission. However, in the absence of therapy, there is a high risk of transition of pathology to a chronic, recurrent form. A rash with syphilis occurs already at the secondary stage of the process, therefore such a symptom is a serious reason for contacting a venereologist as soon as possible.

Unlike most dermatoses, rashes with treponema pallidum are characterized by a number of signs:

• there is no definite localization of lesions of the epidermal cover, the only exception is a hard chancre specific for primary syphilis, which forms at the site of the introduction of treponemes into the skin or mucous membranes;
• there is no predisposition to the fusion of foci of rashes, as a rule, the foci have a well-defined border, although their shape may be different;
• with a long course of the disease, a rash can appear on the body for no apparent reason and also disappear spontaneously without any treatment;
• there are no additional symptoms, for syphilitic rashes, itching, peeling, general the state of health remains within normal limits, with rare exceptions after the disappearance of the rash on the skin does not occur no trace;
• the shade of the lesions varies from pale-flesh at the initial stage to reddish-brown to black;
• the simultaneous presence of several types of rash (for example, spots and papules) is possible;
• rapid disappearance with the selection of the appropriate course of therapy.

In addition, the cutaneous manifestations of syphilis are characterized by a clear periodicity. The disease begins with the incubation period. Its duration varies from patient to patient 2–3 weeks to several months. Pathology manifests with the appearance of a hard chancre. Often there are systemic manifestations (temperature, deterioration of the general condition, etc.). And only then, after a few more weeks, a rash occurs with syphilis. It persists (taking into account periods of remission and exacerbation) until the disease is completely cured.

A person does not immediately find out about infection with syphilis, since the disease begins with the incubation period. Its duration depends on the state of the immune system, the presence of concomitant diseases, concurrent administration of antibiotics (standard dosages for the treatment of the vast majority of bacterial infections are not fully effective against treponema). The primary form of syphilis is characterized by the appearance of the so-called hard chancre. Outwardly, it looks like a rounded ulcer surrounded by a raised roller.

The inner surface is flat and smooth. However, such a skin lesion is painless, when rubbing with clothes or pressing, an ichor can be released. Typically, a chancre forms on an area of ​​the body that has been in direct contact with infected secretions. Usually these are the genitals, during medical procedures or after unprotected oral sex - the mucous membrane of the nasopharynx. Less commonly, a similar sign of syphilis is formed on the abdomen, inner thighs. In such cases, the chancre size can be up to 40-50 mm and more.

Most often, erosive damage to the body lining is single, but sometimes multiple ulcerations may appear. A rare atypical form of primary syphilis is chancre - panaritium. Its distinctive feature is localization, atypical for this disease - on the palms, fingers. In this case, in addition to the ulcer, there is swelling, local hyperthermia, redness.

In most patients, by the beginning of the secondary period of syphilis, the chancre heals even without the use of any external or oral medications. However, it is this stage that is characterized by the appearance of various kinds of rashes. Previously, the pathogenesis of such a course of syphilis was associated with the activity of the treponemes themselves. But in the course of clinical studies, scientists have found that the main physiological reason for the formation of certain symptoms that reflect the stages of pathology is the response of the body.

That is why, for different patients, the timing of different periods of syphilis, and its external manifestations, and the alternation of exacerbation - remission differ. With the primary introduction of treponemes, the human immune system reacts by forming a dense infiltrate. Then, under the influence of all the increasing changes (according to the mechanism of development, they resemble an allergic reaction), the nature and appearance of the skin lesion changes. The end result of the pathological process is gum, specific for tertiary syphilis, with skin necrosis.

Syphilitic roseola

In appearance, such a formation is a stain that does not differ in any way from the surrounding skin except for color. The hue can range from pale-flesh-colored or slightly yellowish to bright red. However, in the vast majority of cases, syphilitic roseola does not have a very contrasting color.

The shape of the rash is variable: spots can be round or have indistinct borders. They are located at a distance from each other, do not merge together. The size of each individual lesion ranges from a few millimeters to one and a half centimeters. Itching, peeling, inflammation of the surrounding tissues is absent.

In the cold, roseola spots become more distinct, the same symptoms are noted at the beginning of therapy with penicillin antibiotics. When pressed, the rash disappears, but after some time it returns again. A distinctive feature of this syndrome is the acquisition of a more intense color when injected with a solution of vitamin PP.

Papular syphilis

This form of the disease is characterized by the appearance of various dense papules. On the body, they can be located separately from each other or in small groups. By itself, the rash does not cause any discomfort, but when pressed, there is an acute painful sensation. As a rule, papules remain on the body for up to 2 months, after which peeling occurs, then the rash disappears. In their place, areas of pigmentation remain for some time.

There are such forms of papular syphilis:

• Lenticular, appears most often, an outwardly similar rash resembles small nodular formations, up to half a centimeter in size. At the initial stage, the outside of the papule is smooth, and then becomes covered with transparent scales. The appearance of such manifestations of secondary syphilis on the face is often accompanied by seborrhea, so the papules are covered with a denser coating. With a recurrent course, lenticular papular syphilis is characterized by the fusion of rashes into groups of different outlines - a semicircle, an arc ring, etc.
• Miliartny, with this form of syphilis, papules do not exceed a few millimeters, they are formed only around the hair follicles (including the cannon) or the ducts of the sebaceous glands. In terms of consistency, the formations are quite dense, sometimes covered with a horny coating. As a rule, miliary syphilis is localized on the arms and legs. Such formations can be accompanied by itching, are prone to a prolonged course, and do not respond well to standard therapy.
• Coin-shaped, differs in the large size of papules (up to 2.5 cm) of a rather characteristic color (from dark brown to purple-red). Usually there are relatively few rashes, in addition, a similar form of syphilis tends to be combined with other types of rashes. Often, the focus of the lesion resembles a fireworks - several small ones are located around a large spot (a similar phenomenon is called blasting or corymbiform syphilis). After the disappearance of the coin-like papule, areas of impaired pigmentation remain. Often, such formations are localized in the area of ​​the groin folds, between the buttocks. In this case, they are often damaged, become wet, and are constantly eroded.

Sometimes the so-called palmar and plantar syphilis is formed. In appearance, they may resemble corns or subcutaneous hematomas, which, as it were, "shine through" through the epidermal cover.

Pustular syphilis

This form of the disease proceeds with the formation of filled exudates of bubbles of various sizes and localization. According to experts, it is very rare, in a maximum of 10 patients out of 100, it is more typical for patients with a weakened immune system, against the background of alcohol and drug abuse. It is not uncommon for this rash to be accompanied by severe fever.

Depending on the external manifestations, the following forms of pustular syphilis are distinguished:

• Eel-like. It manifests as a small lump, in the middle of which an accumulation of pus quickly appears. Usually they have a bright color, as a rule, they are localized in the area of ​​the sebaceous glands (on the face, back, hair growth zone on the head).
• Smallpox. It is characterized by the rapid disintegration of the pustule into a papule surrounded by inflammatory skin. Subsequently, it becomes covered with a dense keratinized crust, soon it disappears, and a small depression remains. The rashes are not prone to fusion, they look like chickenpox, so a number of studies are required for differential diagnosis.
• Impetiginous. At the initial stage, a characteristic pustule appears, which gradually collapses in the central part, forming a rather large abscess. The rash has a bright red color, after the rupture of the abscess, a yellowish or brown dense crust forms.
• Ektim. Characterized by the depth of the process, the pathology covers not only the epidermis, but also the dermis. It is large (up to 10 cm), often covered with a dense crust. It soon falls off, exposing an ulcerative surface bounded by raised skin. After healing, a scar forms at the site of the ecthyma.

Another type of pustular syphilis is the rupee. It is prone to a long course and complex healing processes, in which drying crusts are layered on top of each other, forming something like a shell rising above the surface of the skin.

Herpetiform syphilide

In terms of external manifestations, it is very similar to pustular, however, in terms of pathogenetic changes, it is more similar to the symptoms of tertiary syphilis. Serves as a sign of a severe course of pathology, usually occurs in debilitated patients prone to immunodeficiency, excessive alcohol consumption, drug addiction, against the background of untreated syphilis. In appearance (this is very noticeable in the photo), syphilis herpetiformis is a plaque (their size varies from 1 to 6 cm) of a bright color. From above, they are covered with small bubbles, which looks very much like herpes. However, after a few days, they burst, and the pustules are covered with small sores on top.

Pigmented syphilide

This form of the disease is also called leukoderma. Usually, its manifestations occur six months after infection. Pigmented syphilis is localized in the neck, therefore it is often called the necklace of Venus. At first, the skin appears to have increased pigmentation with uneven outlines, then they brighten. They are not prone to change in size and fusion, they are more often formed in women, as a rule, it is difficult to respond to therapy. Often, such pigmentation disorders are accompanied by the penetration of pathogens into the cerebrospinal fluid.

Skin manifestations of the late period of the disease

Tertiary syphilis occurs against the background of long-term inflammatory processes in the epidermis and dermis. One of the manifestations of the late period of the disease is gum - a rather dense neoplasm, its size can reach a walnut. When pressed, no painful sensations arise.

Gum is formed in the epidermis, therefore it easily moves under the skin, usually forms on the legs, can be singular or merge together. After some time, tissue fluid is released from the middle of the formation. Gradually, the gap grows, which leads to the formation of ulceration, combined with necrosis.

Such lesions can remain on the skin for a long time (sometimes up to several years). After healing, a scar or a depression in the skin may form. Lumpy syphilis is another manifestation of tertiary syphilis.

It is accompanied by the formation of formations of a specific bluish tint, collected in groups. Depending on the individual characteristics of the patient, they can dissolve or flow into ulcers with subsequent scarring.

The clinical picture of congenital syphilis

An infant infected with syphilis intrauterinely has a high probability of death, especially with an early manifestation of pathology. If the disease develops in the first months after birth, symptoms typical of secondary syphilis develop. Congenital syphilitic roseola is characterized by peeling, the appearance of scales, the appearance of a bright red hue. Papular syphilis in children occurs with thickening of the skin on the soles and palms, buttocks. Then the surface of such a formation becomes shiny, and begins to peel off strongly.

With the formation of symptoms of syphilis in the mouth as a result of sucking, screaming, deep cracks appear, their healing is accompanied by the formation of scars. If such rashes are in the nose, a runny nose occurs. In some cases, there is a risk of complete destruction of the nasal septum.

Syphilitic rash: are there any differences in the course of men and women, methods of diagnosis and therapy

Many manifestations of secondary syphilis do not differ between men and women. However, the fairer sex is more likely to form leucoderma ("necklace of Venus"). In addition, there is a certain difference in the localization of acne-like pustular syphilis, since the secretory activity of the sebaceous glands is increased in men. There are quite definite differences in the location of lesions in the genital area.

In men, the initial manifestations of pathology (chancre) are located on the head of the penis, in women - on the mucous membranes of the genitals. In addition, infection in the fairer sex is dangerous in terms of the risk of pregnancy against the background of an active course of the infectious process. With intrauterine infection of a developing fetus, there is a high risk of death of the child, a similar probability persists in the postpartum period.

Some symptoms of treponema pallidum are quite specific, but treatment is not started without confirming the diagnosis. A syphilitic rash should be differentiated from other dermatoses.

This is possible with the help of microscopy of the discharge and specific immunoassay methods, hemagglutination reaction, Wasserman. They can give an unreliable result at the initial stages of the disease, but when skin manifestations occur, such techniques are very specific.

A syphilitic rash is quite amenable to therapy, but the main condition is a timely visit to a doctor. The doctor prescribes a long course of antibiotics from the group of tetracyclines, penicillins, macrolides. In some cases, antihistamines are indicated. Anti-inflammatory topical ointments and gels are sometimes used. However, do not try to cope with the infection on your own, syphilis treatment requires a professional approach.