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A 23-year-old homosexual man had an intensely pruritic, papulonodular eruption over his arms and back (left image). A 52-year-old man with AIDS had reddish papules and nodules—some pustular—over his face, chest, arms, and back (right image).
On dark field examination, the lesions in the homosexual man were teeming with spirochetes. Additionally, his fluorescenttreponemal antibody absorption test was positive. The AIDS patient had a penile chancre and a positive serum test for syphilis. With penicillin therapy, theeruption in both patients rapidly resolved.
Dermatologic manifestations are the hallmark of secondary syphilis. Copper-red papules are most common, but macular, pustular,acneiform, psoriasiform, nodular, annular, or follicular variants can appear. The lesions characteristically do not itch, but as shown in the first patient,pruritus can be the dominant clinical feature.
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