How to distinguish pityriasis rosea or syphilitic roseola. Manifestation of syphilitic roseola and therapeutic measures. Seborrheic papular syphilide

Syphilitic roseola is a skin rash that in itself does not pose a threat to human life, but is a symptom of a dangerous disease. This manifestation indicates that syphilis has passed into an advanced form.

Syphilitic roseola is one of the few external manifestations of secondary syphilis. Outwardly, such rashes have a pink tint, but as the disease progresses they turn pale, are characterized by blurred contours and a smooth surface - this means that they do not rise above the skin. They do not exceed one centimeter in diameter, but can merge into large spots.

The main reason for the occurrence of this symptom is the progression of syphilis and the partial destruction of the microbe, which is the causative agent of the disease. In addition to the unpleasant rash, the clinical picture also includes other symptoms, including weakness, pain and increased body temperature.

The implementation of laboratory diagnostic measures is primarily aimed at carrying out differential diagnosis, since a similar sign can be observed in some other skin pathologies.

Specific treatment of roseola for syphilis is limited to conservative methods.

Roseola rash is diagnosed in approximately 80% of patients diagnosed with syphilis and has a specific nature of occurrence.

The true source of skin damage is a microorganism such as Treponema pallidum. Due to the fact that it has an elongated body shape and a large number of fibrils, it has the ability to spiral movements. This is what causes damage to various areas of the skin on the patient’s body.

Similar skin manifestations of syphilis occur after a few months, less often after five weeks from the onset of the disease. It is noteworthy that roseola is the most specific clinical manifestation of an advanced stage of pathology, which to some extent facilitates the diagnosis, which is carried out by a venereologist or dermatologist.

There are several mechanisms for the occurrence of such an unpleasant skin disorder. These include:

1. damage by the pathogen to blood vessels - the most common localization of syphilitic roseola is the torso, lower and upper extremities, as well as the forehead.
2. destruction of bacteria under the influence of the human immune system - against this background, endotoxin is released. This substance is a rather dangerous poison that has an angioparalytic effect.
3. weakening of the immune system - leads to relapses of this symptom after the first cure.

The secondary period of syphilis, accompanied by the formation of a pale pink rash, can last from two to four years. After this, the disease passes into the tertiary form.

Classification

Currently, the syphilitic rash has several varieties. Depending on the time of appearance there are:

• fresh roseola - is such when it first appears, which occurs gradually, over about ten days. This type of rash is characterized by random skin lesions and spontaneous disappearance after about a few months;
• recurrent roseola - appears in cases where there was no qualified assistance at the initial occurrence of the rash. It is characterized by the fact that under the influence of an etiological factor, namely weakened immunity, larger roseola appear compared to the previous form. The sites of rashes may differ with each relapse.

It is noteworthy that during the treatment of both fresh and recurrent syphilitic roseola, using the injection of antibacterial agents, the pale pink formations will take on a bright red tint, which is considered a completely normal sign.

In addition to the existence of the above typical forms of this symptom, there are several atypical varieties, including:

1. scaly roseola - based on the name, it becomes clear that spots on the skin are covered with specific scales. Some patients compare this skin condition to wrinkled papyrus paper.
2. rising roseola - has the appearance of blisters and rises several millimeters above the surface of the dermis. Despite this, there are no uncomfortable or unpleasant sensations. The main specific feature is that the skin takes on a cyanotic, i.e., bluish tint.
3. confluent syphilide - characterized by the fact that numerous, but not large, spots merge into one pattern of an erymatous nature.
4. follicular or punctate roseola - characterized by the presence of a large number of punctate nodules that have a copper-red hue. During diagnosis, the granular structure of such spots is noted.
5. edematous roseola.
6. ring-shaped - is expressed by the presence of plaques in the patient, which in shape can resemble a circle or semicircle, less often an arc or a garland.

Symptoms

Clinical symptoms accompanying the formation of papules or roseola are very scarce, since the general condition of the person does not worsen, there is no pain, itching or other discomfort.

Nevertheless, the rashes themselves have the following specific signs:

• the volume of spots often does not exceed one centimeter;
• the presence of unclear contours - this is most typical for fresh roseola, because recurrent roseola has a clear border with intact skin;
• lack of tendency to increase in size;
• asymmetrical and smooth surface of the spots, but only in skin tumors of a typical shape;
• with physical impact on the stain, its lightening will be noted, but for a short period of time;
• acquisition of a yellowish-brown hue – observed with prolonged refusal to seek qualified help;
• absence of scarring and other traces after treatment.

Among the few symptoms of syphilitic roseola it is worth highlighting:

1. the formation of a papular necklace, which also has a second name - “necklace of Venus”. In the vast majority of cases, it is localized in the neck area, several times less often - on the shoulders, in the lumbar region, on the arms and legs.
2. minor small focal baldness - like other clinical manifestations, it goes away with the start of treatment.
3. change in voice timbre.
4. headaches of varying severity.
5. pain in muscles and joints.
6. general weakness and malaise.
7. decreased performance.
8. temperature increase.
9. anemia.

It is worth noting that not all patients will experience the presence of such symptoms, which depends on the severity of the underlying illness and the general condition of the immune system.

Diagnostics

Laboratory tests are the basis for establishing the correct diagnosis and carrying out differential diagnostics, but before carrying them out, the clinician must independently perform several manipulations. These include:

• studying the medical history and life history of the patient - this will help to identify the most likely provoking factor that led to the appearance of syphilitic roseola;
• Performing a thorough physical examination to examine the condition of the spots and the skin in general. This will make it possible to accurately determine the type of such manifestation;
• detailed farrowing of the patient plays an important role, because it is very important for the doctor to find out the first time the main symptom appears, whether the person has additional symptoms.

Laboratory blood testing for syphilis is a specific analysis of human biological fluid aimed at identifying antigens and antibodies to the pathogen. Often, a PCR test or RIF analysis is used for this; such studies give a 100% result. Carrying out instrumental examinations of the patient when such a symptom is expressed does not make sense.

Such rashes must be differentiated from other types of spotty rashes, which have almost similar external signs. Thus, syphilitic roseola must be distinguished from:

1. toxic dermatitis.
2. pink or pityriasis versicolor.
3. hypothermia of the body.
4. insect bites.
5. rubella and measles.
6. typhus and typhoid fever.

Treatment

Syphilitic ulcers of this type must be treated in a medical facility under the supervision of a specialist, since independent attempts to eliminate such a symptom can only aggravate the situation.

The peculiarities of therapy are that it must take place in courses, alternate with short breaks and be long-term.

Syphilitic rash can be treated with:

• lubricating problem areas of the skin with mercury ointment.
• using lotions based on saline solutions.
• careful hygienic care of the skin.

For a faster onset of positive effects from treatment, patients should give up addictions. It is worth noting that such therapeutic techniques will only help get rid of such a clinical manifestation, and not from the ailment that caused it.

Possible complications

Since syphilitic roseola is a sign of an advanced form of syphilis, it can lead to the development of the following consequences:

1. frequent recurrences of such a repulsive rash.
2. transition of the disease to the tertiary form - this happens extremely rarely, since the expression of such a specific symptom becomes an impetus for people to seek medical help.

Prevention and prognosis

To avoid the appearance of rashes and ulcers with syphilis, early detection and full treatment of the underlying disease is necessary. There are no other preventive measures to prevent the appearance of syphilitic roseola.

As for the prognosis, it is quite easy to get rid of the symptom itself, you just need to follow all the recommendations of the attending physician, but treatment of syphilis requires a lot of time and patience. In addition, the patient’s condition may worsen if pathologies from the cardiovascular system or gastrointestinal tract are associated, as well as with diabetes mellitus.

Syphilis is not only a sexually transmitted infection; transmission from mother to child during childbirth is also possible. But this is precisely the disease that will be dangerous due to its consequences and complications. Therefore, it is important to take timely measures.

Syphilitic roseola symptoms

The clinical course of syphilis is divided into three stages. The first is characterized by the formation of a hard chancre at the site of entry of the pathogen - this is an ulcer that has a dense and hard base, which goes away on its own within about a month.

After 5 - 8 weeks from the moment the chancre forms, a generalized rash appears. This will be syphilitic roseola - secondary syphilis. These are pink and later paler rashes with blurred outlines and a smooth surface, no more than one centimeter in diameter. The rash grows in waves, several dozen elements every day. Long-standing syphilitic roseola becomes yellow-brown in color. The location of the rash is random, all over the body, but does not affect the face, hands and feet.

In addition to fresh, there is also recurrent syphilitic roseola. In this case, the spots are localized in certain areas of the skin and are less pronounced. This type of rash is characterized by larger sizes and a more bluish color.

In addition to the typical forms of syphilitic roseola, there are also atypical ones:

• scaly roseola, which appears as typical skin flakes that look like crumpled tissue paper;
• roseola elevata - rises above the surface of the skin and resembles blisters, there is no unpleasant sensation.

The third stage, in the absence of treatment, can make itself felt several years later. The entire nervous system, bone tissue, and internal organs are affected. If you become infected with syphilis during pregnancy, with a high percentage of probability, the born baby will have a congenital form of syphilis.

Syphilitic roseola is not dangerous, but is a sign of a serious illness that cannot be ignored. It is important to diagnose it in time and take action, because it is possible to completely cure syphilis only in its first stage; the second and third stages only translate into deep remission.

Treatment of syphilitic roseola

Treatment is carried out only under the supervision of a venereologist. The scheme is developed after the correct diagnosis is made, with additional research methods carried out. Self-medication of syphilis is unacceptable; there will be no effect, and the pathology will continue to develop, affecting new organ systems, which is why the likelihood of a favorable outcome is practically absent.

The treatment period is long and depends on many parameters: the primary process is treated for a couple of weeks, and for the formation of syphilitic roseola - several years. Individual treatment takes place under the supervision of venereologists, at home or in a hospital. Treatment is based on antibacterial therapy; the most effective are antibiotics of the penicillin group.

Syphilis is a curable pathology, but it is important to start therapy immediately; the earlier the diagnosis is made, the more successful and adequate the treatment will be.

The main problem in treatment is late treatment, and there is an explanation for this. When syphilitic roseola appears, patients study the photo and may “make” the wrong diagnosis - an allergic reaction, which is why there is no timely treatment and the outcome of treatment will be unfavorable.

Syphilis is one of the most famous sexually transmitted diseases of our time. The pathology is characterized by a consistent course and characteristic clinical manifestations. Unlike chancre, which is a manifestation of the primary stage of infection, syphilitic roseola accompanies a later stage of the disease - the secondary one. Not only venereologists, but also therapists, dermatologists and other specialized specialists encounter this symptom in their practice.

Features of the pathology

In its development, a syphilitic infection goes through three stages, the symptoms of which replace each other. The first stage - the formation of primary syphiloma (chancre) and the occurrence of regional lymphadenitis - is characterized by the introduction of the pathogen into the body through the skin or mucous epithelium. A developing ulcer-like defect or syphilitic chancre has no subjective signs and goes away on its own in 4-7 weeks, even without treatment.

The first stage of the disease is replaced by the second, associated with the generalization (spread) of infection by hematogenous route. It is characterized by a variety of skin manifestations, one of the most common of which is syphilitic roseola.

In the absence of therapy, the rash persists for 4-5 weeks, and then gradually disappears, giving way to tertiary syphilis, which is characterized by systemic multiple organ damage, the development of serious consequences and often ends in death.

Characteristics of the secondary period of syphilis

Secondary syphilis is a period of the disease characterized by a disseminated rash, characterized by polymorphism, damage to somatic organs, bone and joint tissue, the brain and spinal cord. Another sign of pathology is generalized lymphadenitis, which is an immune response to an attack by antigens.

The period of secondary syphilitic lesions develops 2-3 months after infection. Through the blood vessels, the causative agents of the disease - spirochetes - spread to peripheral tissues and cause a specific reaction. As a result of an active immune response, treponemes are capable of forming cysts and spores, which explains the prevalence. If the body's defenses are reduced, bacteria can become activated and cause a clear clinical picture.

Secondary syphilis usually begins with signs of systemic intoxication - malaise, headache, low-grade fever, myalgia and arthralgia. After approximately 5-7 days, characteristic skin symptoms develop.

Rashes of secondary syphilis, or syphilides, are characterized by great polymorphism. Among them the following varieties are distinguished:

• syphilitic roseola;
• papular (dense) syphilide;
• pustular (pustular) syphilide.

All of them have a number of common features: they are prone to benign growth without spreading to peripheral tissues and their damage, have a rounded shape and practically do not cause subjective symptoms (in rare cases, mild itching is possible). In addition, throughout the active stage of secondary syphilis, there is no pronounced inflammatory reaction, and the rash heals without scarring.

Note! Secondary syphilides contain a large concentration of spirochete pathogens. This causes a high epidemiological danger for patients with this form of the disease.

Most often, patients encounter manifestations of syphilitic roseola, the clinical and morphological features of which are described in the sections below.

Classification of the secondary period

Depending on the characteristics of the pathology, secondary syphilis has several varieties:

• Fresh - develops immediately after primary syphiloma, lasts 2-4 months. Typical manifestations are a widespread polymorphic rash, chancre at the resorption stage, polyadenitis.
• Latent – ​​characterized by the absence of clinical manifestations with positive serological tests.
• Recurrent - accompanied by alternating periods of active and latent syphilis. With each relapse, the patient develops a rash, but it is less bright and profuse. The arrangement of skin elements is also considered atypical: they are localized in groups, forming semirings, rings, arcs and garlands.

Roseola is the most common manifestation of syphilis

Macular or roseola syphilide is a frequently diagnosed skin symptom. It appears earlier than others and indicates that the disease has acquired a generalized form.

Roseola in syphilis is round, pale pink elements that do not protrude above the surface of the skin, the diameter of which does not exceed 6-10 mm. They are localized throughout the body, but a large accumulation of them can be observed on the skin of the torso, arms and legs. The rash appears gradually, in the amount of 10-12 elements per day. The skin syndrome reaches its peak approximately on the seventh day of the disease.

In addition, the classic roseola rash that develops with syphilis has the following symptoms:

• unclear boundaries and slightly blurred outlines;
• no tendency to merge;
• smooth surface;
• the elements of the rash do not change in diameter (do not increase, but do not decrease);
• when pressed with a finger, roseola becomes lighter, but after the mechanical pressure stops, it quickly returns to its previous color;
• rashes are not accompanied by subjective sensations (pain, itching, etc.);
• rarely located on the face, palms, soles of the feet.

With recurrent syphilis, the nature of the skin rash changes. With each exacerbation, the number of rash elements becomes smaller, but they have a larger diameter (13-15 cm). The spots are located asymmetrically and can merge with each other to form large areas of damage. Similar roseola are pale pink in color and are located mainly on the skin and mucous membranes of the perineum, groin, genitals, and mouth. Another distinctive feature is the ability to form ring-shaped, semi-ring-shaped formations.

Among the more rare forms of spotted syphilide, raised and scaly roseate elements are distinguished. The former rise above the surface of the skin, which makes them look like burn blisters, while the latter peel off in a plate-like manner and have a small depression in the center.

The draining area usually occurs with a recurrent form of the disease. It is characterized by the combination of numerous spots into a single erythematous pattern. Follicular (synonym: granular) roseola is extremely rarely diagnosed. In this case, pathological skin elements are represented by many pinpoint nodules of a reddish or copper hue with a granular structure.

Other skin symptoms should be distinguished from roseola rash. Thus, papular syphilide is characterized by the formation of many dense copper-red papules with a diameter of up to 3-5 mm. Like scaly roseola, these rash elements are prone to the appearance of fine-plate peeling, spreading from the center to the periphery. Another characteristic sign is the presence of a “Biette collar” - ring-shaped peeling along the border of the papule. The resolution period is longer than with roseola, since areas of residual hyperpigmentation remain on the skin of patients for a long time.

Much less common is pustular syphilide, which differs from roseolous syphilide in the presence of purulent exudate, which flows out with the formation of yellow crusts throughout the body. In addition, lenticular (lenticular) and coin-shaped varieties of pustular syphilide are considered rare forms of skin manifestations of infection. The first consists of many large papules in the shape of a flattened hemisphere with a diameter of up to 12 mm. Their color varies from reddish pink to bright scarlet. The size of the coin-shaped elements of the rash is 18-25 mm. Has an intense dark color.

With secondary recurrent syphilis, leukoderma often develops - round whitish spots localized around the neck.

Modern diagnostic methods

Diagnosis of spotted roseola and secondary syphilis is based on the characteristic clinical picture. The doctor should keep in mind a sexually transmitted infection in all cases of generalized rash and systemic polyadenitis.

The diagnosis is confirmed using laboratory examination methods:

• Dark field microscopy is a bacteriostatic study of the discharge from the elements of the rash, during which the doctor can detect pale treponema with their characteristic rotational movements;
• RPR test is a study carried out to identify antibodies to the cardiolipin antigen formed in the blood of patients. Similar to the previously popular RW (Wassermann reaction), but more specific and diagnostically significant.
• Biopsy of enlarged lymph nodes followed by morphological examination.
• Lumbar puncture with determination of spirochetes Tr. Pallidum in the cerebrospinal fluid (the pathogen is often detected both during fresh generalization of infection and at the time of relapse).
• Serological tests (RIF, RIBT, RPGA) - for secondary syphilis are positive in 99-100% of cases.

In addition, the patient may require consultation with specialized specialists: urologist, gastroenterologist, neurologist, otorhinolaryngologist.

Differential diagnosis

Spotted syphilide is similar to many other diseases that are accompanied by the appearance of a pink rash on the skin. Common pathologies with which secondary syphilis has to be differentiated are presented in the table below.

Note! In difficult diagnostic cases, an interesting test is used to confirm secondary syphilis: the patient is injected intravenously with 3-5 ml of a 0.5% solution of nicotinic acid. If the skin manifestations are caused by Treponema pallidum, the color of the spots becomes brighter.

In addition, the presence of the following additional symptoms speaks “for” syphilis:

• baldness (focal or widespread) – occurs in ¼ of patients, quickly stops with the start of therapy;
• hoarseness of voice;
• coughing caused by damage to the vocal cords;
• enlargement of the main groups of lymph nodes.

Principles of treatment of secondary syphilis

With the timely initiation of a set of therapeutic measures, therapy for secondary syphilis is effective in more than 90% of cases. After the diagnosis is established, the patient receives several recommendations regarding lifestyle modifications. Anti-epidemiological measures are also important:

• during treatment, all sexual contacts should be stopped;
• All sexual partners of the patient over the past 12 months are subject to examination and treatment;
• If the patient is being treated at home, measures are taken to prevent infection of loved ones:
  • using separate washcloths, soap, towels and other personal care products;
  • food from separate dishes;
  • accommodation in a separate, regularly cleaned and ventilated room.

Since even with the above measures the risk of infection remains, patients with active skin rashes are usually treated in an inpatient setting.

The main method of therapy is antibiotics. The drugs of choice are penicillins. As a rule, they are prescribed in injection form, which facilitates their better penetration into peripheral tissues:

• water-soluble penicillins are administered intramuscularly every 3-4 hours (up to 8 times a day);
• benzylpenicillin salts – 2 times a day;
• Bicillin and other long-acting drugs (used for outpatient therapy) – once every 2-3 days.

The course of treatment is determined by the doctor individually depending on the clinical characteristics of the disease and the results of the examination.

If the patient is allergic to penicillin antibiotics, reserve drugs are used - Doxycycline, Tetracycline or macrolides (Azithromycin, Clarithromycin, Erythromycin).

As part of complex therapy, venereologists prescribe drugs with stimulating, immunomodulating properties (Methyluracil, Pyrogenal), as well as multivitamins.

Local treatment for syphilitic roseola consists of lubricating the rash elements with antiseptic solutions (Chlorhexidine, Furacilin), as well as treating them with heparin ointment for rapid resorption.

The question of whether secondary syphilis is curable is individual for each patient: there are no universal criteria. It is solved taking into account the following data:

• clinical diagnosis before starting therapy;
• features of the pathology;
• the general health of the patient;
• quality of treatment provided;
• results of dispensary observation.

Roseola rash is the first and main sign of generalization of the infectious process and the development of a secondary form of syphilis. At this stage, one cannot hesitate, since irreversible pathological changes are already beginning to occur in the body, and the patient poses a serious epidemiological danger. Timely initiation of therapy and strict adherence to all doctor’s recommendations contribute to a speedy recovery and prevent the development of dangerous complications.

Syphilitic roseola (spotted syphilide) is the most common skin manifestation of syphilis in the fresh secondary period. Fresh roseola is often the size of a lentil, less often reaching the size of a silver ten-kopeck coin. When it appears, it is pink-red, in a mature state it is bluish-red, and during reverse development it acquires brownish tones. When pressing on a fresh element, the redness causing roseola disappears, only to reappear when the pressure stops. Syphilitic roseola is characterized by faded tones; it has a bright color only as an exception, acquiring it at the beginning of treatment and worsening with the so-called Herxheimer reaction. Some patients with roseola experience hemorrhages that do not disappear with pressure. When pressing on roseola in the stage of reverse development, when pigment is already formed, a yellowish spot appears. Roseola rarely produces perfectly regular rounded outlines; however, its boundaries are quite rubbery, although they are not always easily determined by the eye due to the lack of contrast. The surface of syphilitic roseola is always smooth, and this is its significant difference from roseola, observed in a number of diseases (Gibert's pink lichen, toxic roseola, pityriasis versicolor, measles, scarlet fever, rubella).

Syphilitic roseola never peels off. In addition, syphilitic roseola differs from elements of pityriasis rosea in its less acute nature, lack of peripheral growth, and uniformity of rashes. Toxic roseola has a more acute character, irregular outlines, and quickly develops back when the toxic agent is removed. Pityriasis versicolor has irregular outlines, uneven, merging yellowish-brown spots. With pityriasis versicolor there are no macroscopically noticeable signs of inflammation (redness, swelling). Measles, scarlet fever, rubella, in addition to a number of their characteristic symptoms, are distinguished by the acute nature of the rashes. The measles rash begins on the face, which syphilitic roseola usually spares. Scarlet fever rash has the appearance of purplish-red erythema and usually begins on the chest. Roseola in typhoid and typhus is accompanied by a general severe condition (status typhosus) and other typhoid symptoms. With syphilis, sometimes, despite the high temperature, the general condition suffers little. In some cases, so-called “louse spots” (maculae coeruleae), i.e., pigment spots that appear after a pubic louse bite, are mistaken for syphilitic roseola. These pigment spots are gray-steel in color and are usually located on the side of the body or in the lower abdomen. When pressed, they do not disappear, but even appear more clearly and in more contrast against the bloodless white background of the skin.

Histologically, with roseola, the process is localized in the upper layers of the dermis, where a moderate infiltrate of lymphocytes, plasmatic cells, histiocytes, and erythrocytes is deposited around the vessels. The vessels are dilated, their endothelium is hyperplastic. The swelling is insignificant, but even in cases where it is more pronounced, roseola seems to rise slightly above the level of the skin and... bears some resemblance to the blister (roseola urticata elevata). If the infiltrate is deposited not only around the vessels of the dermis, but is especially clearly expressed in the circle of sebaceous hair follicles, then roseola will have a granular appearance (roseola granulata), since the follicles on its surface will protrude somewhat above the skin level. In old roseolas, red blood cells, when disintegrating, leave behind clumps of pigment, which causes a brownish tint and subsequent pigmentation.

Recurrent roseolas are larger, paler, and often have a ring-shaped outline; their number is much smaller, they are located in limited areas of the skin, i.e. they are regional in nature. Recurrent roseola resists specific treatment more stubbornly than fresh roseola. Neither fresh nor recurrent roseola cause subjective sensations in the patient.

Roseola can be localized on any area of ​​the skin and mucous membranes. It is still rarely observed on the face, neck, or scalp. It is difficult to detect on the palms and soles due to the thickness of the stratum corneum. It can appear on the mucous membranes of the mouth and genitals, where due to the low contrast (redness on a red background) it is rarely recognized. It is more often and easier to recognize when localized on the tonsils and soft palate. In such cases, it gives a picture of an erythematous sore throat with sharp boundaries and minor subjective sensations, which is what distinguishes it from banal sore throats.

To confirm the syphilitic cause of the disease, additional studies are carried out:

Leucoderma

When treponema spreads through the bloodstream, the body begins to fight the infection and produces antibodies. When the microbe interacts with the immune system, biologically active substances are released, leading to the development of manifestations of secondary syphilis. One such sign is a syphilitic rash.

How to determine what causes skin changes? If a rash of unknown origin appears, you should consult a dermatologist. In many cases, the diagnosis becomes clear upon examination.

For ulcers and gummas, you can use syntomycin emulsion, Levomekol ointment, and talcum powder. There is no need to treat the surrounding skin with antiseptics.

Papules are not found on the dorsum of the hands. Most often they are located on the back, back of the head, forehead and around the mouth.

A chancre may be located on the lips or tongue. In the latter case, a slit-like or star-shaped defect occurs.

Skin manifestations also accompany the congenital form of the disease.

In addition to the most common, typical syphilitic roseola, scaly or elevating forms of the disease can also be observed. The rashes themselves are not dangerous, but require urgent medical attention.

A large number of elements appear after the completion of the primary period. This period is about 10 weeks after infection or 1.5-2 months after the onset of chancre. Small bright spots or compactions appear, located symmetrically. When the disease relapses, syphilides appear in much smaller quantities, are located in a limited area of ​​the skin, and are grouped into rings or garlands.

How does a rash appear with syphilis in the late phase:

Perhaps they constitute a transitional stage of macular syphilide to papular syphilis. In relatively rare cases, with a very heavy rash, individual spots cluster closely together in places. And they begin to come into contact with each other: the so-called confluent roseola is formed - roseola confluens.

Syphilide herpetiformis

To prevent an allergic reaction to antibiotics, antihistamines, such as Claritin, are often prescribed.

Sometimes an ulcer does not form, and the gumma heals with the formation of a subcutaneous scar. The skin above it retracts. Gumma can also calcify. The knot becomes very dense, shrinks slightly and lasts indefinitely.

1. the rash can be of different shapes and colors, which is due to the presence of different elements at the same time (papules, pustules, and so on), as well as rashes of the same type at different stages of development; these are true and false polymorphisms, respectively;
2. treponemal tests (immunofluorescence reaction, treponemal immobilization reaction);

The first symptoms of a syphilitic rash appear at the end of the incubation period, which on average lasts from 2 weeks to 2 months. A defect with a diameter of 2 mm to 2 cm or more appears on the skin or mucous membrane. The primary lesion is called a chancre and looks like a round ulcer with smooth edges and a smooth bottom, often saucer-shaped.

3. The surface of the rashes is smooth, and they themselves do not merge with each other;
4. The outlines of the spots are unclear, size - up to 1 cm;

Impetiginous syphilide

Rosacea rash is reported in 75% of patients. It is represented by small round or oval spots with uneven, as if torn outlines. The elements are often a faded pink color, sometimes they are any shade of red - from pale pink to deep crimson. The color of the rash may be different in the same patient. When pressed, roseola disappears. Outwardly, it resembles small splashes of paint.

Small-spotted syphilids develop in the form of bright red or pale red spots, sharply delimited from the surrounding skin. There are round or oval shapes. The size is from the head of a pin for a fresh rash, to the nail of the little finger for relapses. Do not rise or rise slightly above the skin. In the latter cases it is called roseola elevata s. urticate and is observed with fresh, profuse rashes or turns into such after the start of vigorous specific treatment. Roseola, as a rule, does not cause subjective sensations. Fresh small-spotted syphilides pour out in large quantities.

Roseola with syphilis: symptoms

Histologically, with ordinary syphilitic roseola occurs

How to treat a syphilitic rash?

And since only temporary, unstable changes are observed in the skin itself, roseola disappears gradually without any lasting trace.

Syphilitic roseola, like other skin rashes that appear with syphilis, is evidence that the disease has entered the secondary stage. If we talk about specific timing, then such a rash appears several weeks (from 5 to 8) after the onset of symptoms of the primary form of the disease - chancre. If you are interested in what syphilitic roseola looks like, the photo will help you understand as accurately as possible, since there are quite a lot of diseases with similar symptoms.

When differentiating from erythema multiforme, one must take into account the onset of the latter in favorite places. Almost always on the extensor surfaces of the limbs, bluish coloration of elements, etc. You can mix roseola with it only in the initial period of its rash. The spots from the bite of the flathead are usually duller, grayish-blue and are located mainly on the pubis and lateral surfaces of the abdomen and in the armpits. Recognition can be difficult only when they appear abundantly. Marbled leather differs from plum roseola by the development of a network with colored crossbars and pale loops. Elements of pityriasis rosea form typical medallions and are accompanied by peeling.

Syphilitic ecthyma can form on the legs - a large (up to 2 cm) ulcer, covered with a thick crust and surrounded by a purple rim. As the formation grows and gradually dries out, a shell-shaped crust is formed - a syphilitic rupee. Such an ulcer heals poorly and a scar remains in its place.

• detection of treponemas in discharge from chancre or erosions;

This infiltration consists of plasma cells, lymphocytes and erythrocytes, which gradually disintegrate. As a result, with long-existing roseola spots under pressure, a slight brownish or even yellowish color may remain due to the presence of erythrocyte hemosiderin in the skin.

The papules are located separately from each other, but with constant friction with clothing or in the folds of the skin they can merge. At the same time, they dissolve in the center, which leads to the formation of various shapes. The surface of such rashes is smooth, shiny, and the color ranges from pale pink to bluish-red and copper. When resolved, they often become covered with scales, leaving behind pigmentation. Sometimes the papules ulcerate or enlarge, turning into broad condylomas.

It is associated with the reactivation of treponemes at the site of the disease. Such elements are usually not contagious. They have a tendency to spread peripherally.

• pustules (papular-pustular rash);

In each phase of the disease, rashes with syphilis have their own characteristics.

Usually such a complaint is uncharacteristic. However, in recent years, there have been more and more cases of rashes accompanied by moderate itching.

Syphilitic roseola: symptoms

What is never observed with roseola. So it is difficult to mix them: only at the beginning of the rash can they have some resemblance to roseola. With lichen versicolor, the rash is not inflammatory, the spots are brown in color and flaky. When the elements of the rash are lubricated with iodine tincture, the color becomes more intense - the signs are not typical for roseola.

The erosion is similar to an ulcer, but does not have clearly defined edges. This is a superficial defect that may go unnoticed. Hard chancre or erosion is most often single, but several foci can form.

Spotted syphilide or syphilitic roseola(roseola syphilitica). It is the most common manifestation of syphilis of the secondary period, observed both in the form of a fresh rash and in the form of relapses.

• non-treponemal tests (microprecipitation reaction or rapid reaction with plasma);

In the late period of the congenital form of the disease, gummous and tuberculate formations (syphilides) typical of the tertiary period are found.

Primary syphilis

Recognizing typical roseola does not present any particular difficulties in most cases. It appears suddenly, does not itch, does not peel, and has a number of characteristic accompanying signs of syphilis. That is, the remains of hard chancre, primary adenitis or even polyadenitis. Blood reactions in this case are usually positive. In some atypical cases, roseola has to be differentiated from infectious erythema - typhoid, rubella, measles. In these cases, the general symptoms of these infections, the localization of the rashes, their nature, as well as persistent seroreaction must be taken into account.

What does a rash look like during different periods of syphilis: description and photo

Laboratory diagnosis of syphilis is quite difficult. It is difficult to interpret the results yourself, so consultation with a doctor is necessary.

Small ulcers are more common in women and are located on the mucous membranes. Giant chancre with a diameter of up to 5 cm are localized on the skin of the abdomen, inner thighs, perineum, chin, upper limbs (hands and forearms) and are recorded mainly in men.

• enzyme immunoassay (passive hemagglutination reaction).

Does the rash with syphilis itch?

Tertiary syphilis

How to recognize a syphilitic rash?

With tubercular syphilide, limited dense painless tubercles of a bluish-red color, up to 1 cm in size, form on the skin. They can ulcerate with the formation of deep defects with a steep edge, covered with a crust and healing with the formation of a scar. Such outbreaks exist for several months.

Timely treatment of syphilis allows you to avoid the serious consequences of this disease, in particular, the formation of scars on the skin.

• bubbles (vesicles);

Syphilitic leukoderma is usually observed in women in the neck, on the sides and back, forming the so-called necklace of Venus. Less commonly, it is observed on the body, on the legs or arms, in the armpits. Initially, spots with increased pigmentation of a yellowish tint appear. In the center of such lesions, discoloration begins in the form of spots. They can merge to form a “lace” or “marble” pattern. There is no peeling or itching.

A papular rash is formed due to inflammatory impregnation of the upper layer of skin and consists of raised, compacted lesions. They have clear boundaries and are well demarcated from the surrounding skin. To the touch they are dense, hemispherical or pointed.

Syphilitic rashes, in order: syphilitic ecthyma, plantar syphilide, leucoderma

• bumps and gummas on the skin;

Syphilis is an infectious disease caused by the microorganism Treponema pallidum, or Treponema pallidum. The pathogen enters the human body through damaged skin or mucous membranes. The microorganism can be transmitted through the placenta and through blood transfusion.

In some cases, during relapses, the spots form various shapes, for example, rings, garlands, and the result is ring-shaped roseola - roseola annularis.

• Miliary is located at the mouths of the hair follicles and consists of nodules with a diameter of 1-2 mm. They are round in outline, dense, covered with scales, and pale pink. Such elements are located on the body and on the outer surfaces of the limbs, where there are hairs. Sometimes they are accompanied by itching.

Read more information about routes of infection, diagnosis and treatment of syphilis in our previous article.

Gumma is a dense node up to 3 cm in size, rising above the surface of the skin, painless. The skin over it gradually becomes purple in color. The typical location is a single lesion on the anterior surface of the leg.

Spots in secondary syphilis

Papular syphilide can be represented by skin infiltration. The skin thickens, turns red, swells, and then peeling begins. This sign appears on the palms, soles, buttocks, as well as around the mouth and chin. The affected skin is damaged with the formation of radiating cracks. After they heal, scars remain for life. The nasal cavity and vocal cords are affected.

The most striking manifestation is papular syphilides, which have different appearances:

• The rash is not accompanied by pain or itching;

Syphilitic roseola: how to recognize

Syphilitic pemphigus

Acne is represented by several small conical blisters located on a compacted base. The blisters become covered with crusts, which fall off after 2 weeks. Scars usually do not form.

In the future, the gumma may soften and open, forming a large ulcer. Its edges are dense, painless, steep, and the bottom is deep, covered with dead tissue. This ulcer lasts for many months. After healing, a rough scar is formed, often acquiring a star-shaped outline.

Rashes with tertiary syphilis appear 3-5 years after infection. However, cases have been described in which skin manifestations occurred after 10-30 years. They are often associated with improper treatment of the disease.

• treatment leads to rapid disappearance of rashes;

Without treatment, each roseola element lasts an average of 2-3 weeks and then slowly and completely disappears.

• thickening of the walls of blood vessels,

Skin manifestations may be a sign of primary syphilis, when the microbe multiplies directly at the site of penetration. This is how hard chancre is formed.

If you have carefully read the photo, but are still not sure that your rash is associated with sexually transmitted diseases, pay attention to the following symptoms that accompany the rash:

The skin manifestation of primary syphilis is always accompanied by enlargement of nearby lymph nodes.

Congenital syphilis

What do the rashes look like? Most patients with secondary syphilis develop spots (roseolas), less often small elevations (papules).

• an itchy rash is unusual; elements gradually disappear, leaving no traces behind;

In 2-10% of patients, formations in the form of vesicles (pustules) occur. They are observed in weakened patients and resemble acne, impetigo or other dermatoses. In differential diagnosis, it is important to consider that such formations are surrounded by a copper-red rim.

One of the atypical forms of primary syphilis is chancre-felon. It forms on the fingers. The affected phalanx swells greatly, turns red, and becomes sharply painful. A deep, irregularly shaped ulcer is visible on the skin.

The ulcer is painless, the discharge from it is insignificant. It is located in a compacted area - infiltrate. It is very dense and resembles to the touch thick cardboard, cartilage, rubber.

• nodules (papules);

Secondary syphilis

Treponemas multiply intensively at the site of damage, so the primary chancre can serve as a source of infection for other people. The ulcer lasts for approximately 7 weeks, after which it heals to form a scar.

• With mechanical pressure, the rash spots lighten, but very quickly restore their previous color;

Where does the rash appear in secondary syphilis? It can occur on any part of the body. Despite the variety of symptoms, all secondary syphilides (skin manifestations) have common signs:

Roseola with syphilis

If you suspect syphilis, contact the author of this article - a venereologist in Moscow with 15 years of experience

Syphilitic ecthyma

• and also there is a small round cell infiltration around the vessels.

With elevated or urticarial roseola, in addition, slight swelling and dilation of the lymphatic vessels are observed. With granular roseola, the perivascular infiltrate is more pronounced. The epidermis over roseola spots does not change. Therefore, roseola does not peel off.

Leukoderma is very characteristic of relapses of secondary syphilis. It appears six months after infection and persists for several months and even years, but sometimes disappears much faster. Interestingly, Treponema pallidum is not found in the affected skin. This rash is resistant to treatment.

• originality of color: at first bright pink, then turning into brownish and gradually turning pale; the rash may acquire a reddish, yellowish, pinkish tint;

The rash on the hands (palms) and soles is visible under the skin in the form of brown, gradually yellowing spots with clear boundaries. Sometimes papules appear in the form of calluses.

There are small and large spotted syphilides.

• proliferation of endothelial and adventitial cells,

If you are intolerant to penicillins, macrolides or tetracycline may be prescribed.

When roseola appears, it has a bright pinkish-red color. Roseola that has existed for a long time changes its color and becomes light brownish. In some cases, sometimes on older elements of the rash, small papular elevations (roseola granulosa) can be seen in their central part.

How long does a syphilitic rash last during the secondary period?

Syphilitic roseola, if left untreated, tends to recur at varying intervals. In fresh forms of syphilis (s. II recens), the number of rash elements is abundant and the rash is located symmetrically.

• limited vasodilation, mainly of the superficial and less of the deep network of the skin itself,

A rare manifestation of severe secondary syphilis is syphilide herpetiformis, which resembles herpes blisters. It occurs in patients with alcoholism or severe concomitant diseases and indicates an unfavorable course of the disease.

Usually it lasts 1-2 months, gradually disappearing. With relapses, syphilides appear again. Under the influence of therapy, the rash quickly disappears.

The spots are located separately from each other, do not merge or peel off. In terms of consistency and texture, they do not differ from the surrounding skin. Their diameter ranges from 2 mm to 1.5 cm. They become more noticeable when the skin cools, for example, during an examination. Roseola without treatment lasts up to 3 weeks and is located on the back, chest, abdomen, and less often on the forehead.

• the skin around the syphilides does not become inflamed or swollen;

Tertiary, or late syphilis occurs a long time after infection. It is accompanied by damage to the bones, nervous system and other organs. A rash with syphilis in the late period is one of the common manifestations of the disease.

• elements of the rash do not spread around the periphery and do not merge, remaining limited;

First of all, it is necessary to prescribe antibiotics that destroy the pathogen. Penicillin preparations of varying durations of action are used. Under the influence of medications, the rash disappears quite quickly.

Manifestations of syphilis on the skin

Syphilitic pemphigus is another typical manifestation of congenital syphilis. Blisters with transparent contents, up to 2 cm in size, are formed on the skin, surrounded by a red rim. They always appear on the palms and soles. The bubbles do not increase or merge. At the same time, internal organs suffer, and the child’s general condition worsens significantly.

A rash with secondary syphilis is a typical manifestation of the disease that occurs in most patients. The appearance of the rashes varies:

How long does it take for a syphilitic rash to appear?

There are certain diseases, and syphilis of the secondary period is also one of them, which are difficult to diagnose due to the fact that the manifestations may be characteristic of not one, but several diseases at once. It is enough to study the photos of rashes in patients with this diagnosis available on the Internet and compare them in the photo, for example, with allergy symptoms, and it will become clear why many people are in no hurry to seek medical help: they are simply confident that there is nothing dangerous for them Roseola does not bring health benefits, and therefore it is not necessary to take measures. It is important to remember that roseola in syphilis is already a signal that time has been lost: if at the first stage the disease is cured completely, leaving no consequences, then the second can result in irreversible disorders, and at the third, only stabilization of the condition is possible, but not cure.

Recurrent roseola rash occurs between 6 months and 3 years after infection. Very often it appears in the mouth, on the soft palate and tonsils. The rash is red with a bluish tinge, the elements are clearly visible against the background of the normal mucous membrane and resemble a sore throat. In most cases there is no sore throat, fever or other general symptoms. At the same time, ulcers often appear in the oral cavity, on the walls of the larynx and vocal cords. This causes hoarseness.

Syphilitic roseola is characterized by the absence of peeling, even with its reverse development.

With early congenital syphilis, which manifests itself soon after birth, typical secondary syphilides are often observed. However, this form of the disease is characterized by special skin manifestations.

Diagnosis and treatment

• spots (roseola);
• A coin-shaped papule is characteristic of a relapse of the disease. It is a hemispherical compaction with a diameter of up to 2.5 cm or more. The color of the formation is bluish-red or brown. Papules form in small numbers, are often grouped and combined with other skin manifestations. After they disappear, pigmentation and a scar remain. If such a papule is located in an area with increased sweating (genital organs, mammary glands, neck), it turns into a very contagious weeping syphilide.

They are located symmetrically on the lateral surfaces of the body and on the abdomen, and do not have negative localization. The rash can also occur on the palms and soles.

Impetiginous syphilide is formed by a compaction - a papule, which after a few days suppurates in the center, forming a large layered crust. With the smallpox form, up to 20 papules up to 1 cm in size are formed, which quickly dry into crusts. Such elements are stored for 1.5-2 months.

Leukoderma is observed mainly during relapses. It is resistant to treatment and can persist for a long time even after recovery. Such a lesion is often accompanied by specific changes in the cerebrospinal fluid.

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