Histologic features of secondary syphilis: A multicenter retrospective review

Alexandra Flamm, Kruti Parikh, Qiang Xie, Eun Ji Kwon, Dirk M. Elston

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Background Secondary syphilis has a wide spectrum of clinical and histologic manifestations. Objective We sought to determine the frequency of histopathological features characterizing secondary syphilis, and which are most common in specimens displaying few diagnostic findings. Methods In a multicenter, retrospective analysis of biopsy-proven secondary syphilis, cases were subcategorized by the number of histologic characteristics present. Results The 106 cases mostly had 5 to 7 of the features studied. Many features were scarcer in cases with 5 or fewer features, including endothelial swelling (87.7% overall vs 72.4% ≤5 features), plasma cells (69.8% vs 48.3%), and elongated rete ridges (75.5% vs 27.6%). Specimens with 5 or fewer features were more likely to be truncal (61.1% vs 34.4% overall), demonstrate rete ridge effacement (44.8% vs 19.8%), and have pityriasis rosea (33.3% vs 17.2%) or drug eruption (33.3% vs 10.9%) in the clinical differential. An interstitial inflammatory pattern was the most common characteristic of specimens with 5 or fewer features (75.9%). Limitations This was a retrospective review. Conclusion The independent value of many histologic features of syphilis may be overestimated. Combinations of endothelial swelling, interstitial inflammation, irregular acanthosis, and elongated rete ridges should raise the possibility of syphilis, along with the presence of vacuolar interface dermatitis with a lymphocyte in nearly every vacuole and lymphocytes with visible cytoplasm.

Original languageEnglish (US)
Pages (from-to)1025-1030
Number of pages6
JournalJournal of the American Academy of Dermatology
Issue number6
StatePublished - Dec 2015

All Science Journal Classification (ASJC) codes

  • Dermatology


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