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J Am Acad Dermatol. 2019 Jul 12. pii: S0190-9622(19)32366-7. doi: 10.1016/j.jaad.2019.07.011. [Epub ahead of print]

Histopathological Features Distinguishing Secondary Syphilis from its Mimickers.

Author information

1
Penn State Hershey Medical Center, Department of Pathology and Dermatology, Hershey, PA. Electronic address: aflamm@pennstate.health.psu.edu.
2
Penn State Hershey Medical Center, Department of Pathology and Dermatology, Hershey, PA.
3
SUNY Downstate Medical Center, Department of Dermatology, Brooklyn, NY.
4
Dermpath Diagnostics New York, Port Chester, NY.
5
University of South Carolina, Department of Dermatology, Charleston, SC.

Abstract

BACKGROUND:

Syphilis is often misdiagnosed clinically, and biopsies may be required.

OBJECTIVE:

To determine histopathological features that distinguish secondary syphilis from pityriasis lichenoides (PL), pityriasis rosea (PR), and early mycosis fungoides (MF).

METHODS:

Histopathological features of 100 cases of syphilis, 110 cases of PL, 72 cases of PR, and 101 cases of MF were compared.

RESULTS:

Elongated rete ridges and interstitial inflammation favor syphilis over PL (likelihood ratios 3.44 and 2.72 respectively), but no feature reliably distinguishes between them. Secondary syphilis and PR may be distinguished by neutrophils in the stratum corneum, plasma cells, interface dermatitis with lymphocytes and vacuoles, and lymphocytes with ample cytoplasm. Plasma cells and lymphocytes with ample cytoplasm are rare in early MF and can be distinguishing features.

CONCLUSIONS:

Histopathological features characteristic of syphilis may be seen in PL, PR and early MF. It may be difficult to distinguish syphilis from PL histologically and a high index of suspicion is required. While elongation of rete and interstitial inflammation favor syphilis, plasma cells, historically considered a significant feature of syphilis, are often encountered in PL. Vacuolar interface dermatitis with a lymphocyte in every vacuole is considered characteristic of PL, but this feature was more common in syphilis.

PMID:
31306731
DOI:
10.1016/j.jaad.2019.07.011

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