Secondary syphilis.

The cutaneous manifestations of syphilis are many. Most commonly one sees macular, papular, and papulosquamous lesions. Rarely, except in infants, are the lesions vesicular and only occasionally are they pustular (Pillsbury, Shelley, and Kligman, 1956; Pariser, 1964). The pustular lesions may easily be misdiagnosed unless the clinician is aided by the presence of a persistent primary lesion or more characteristic secondary lesions. Current text-books consider pustular secondary syphilis to be a very rare entity that occurs in vagabonds or debilitated persons either as a purulent breakdown of lesions that are initially papular (Lomholt, 1968) or as a superimposed pyoderma (Fitzpatrick, Arndt, Clark, Eisen, Van Scott, and Vaughan, 1971). Older texts (Becker and Obermayer, 1947; Ormsby and Montgomery, 1943; Sutton and Sutton, 1939; Stokes, Beerman, and Ingraham, 1944) must be referred to for a more thorough description of this entity, although it was considered an infrequent occurrence even then. The following report describes a case of pustular secondary syphilis seen recently at our institution.