Macerated Plaques Of Toe Webs

Macerated plaques (condylomata lata) of toe webs

Clinical manifestation of secondary syphilis – macerated plaques of toe webs

Striking outbreaks of syphilis have occurred in recent years in China, Russia, Canada, USA and some areas of Central and Eastern Europe. Syphilis is caused by an anaerobic filamentous spirochete Treponema pallidum. Similarly, it has become more common because of the false sense of security that sexually transmitted diseases are curable, sexual promiscuity and the growing sex industry.

The initial presentation of syphilis is generally in the oral cavity

Secondary syphilis is clinically the least difficult to diagnose. In addition, the clinical manifestations of syphilis, for example, the macular rash can be confused with a variety of skin diseases, in some cases. For example, conjunctivitis, urethritis, reactive arthritis, lichen planus, pityriaisis, drug eruption, psoriasis and eczema can be mimicked by syphilis.

Oral chancres are found in 4 to 12% of patients with primary syphilis and occur at the site of organism penetration into the mucosa. Anatomical sites that are affected commonly include lips, soft palate, gingiva and tongue.

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Oral chancre in woman who had unprotected oral sex

However, the manifestations in secondary syphilis are quite variable. A characteristic feature of the lesions is multiple mucous patches that are slightly raised, surrounded by eryhtema and covered by greyish, white pseudomembranes. Typical sites are vestibular mucosa, tongue, pillars and soft palate.

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Mucous patches of the lower vestibular mucosa

Secondary syphilis may show unexpected features in some patients

Condyloma lata are white, grey mucous patches that are found mainly in the anal or genital areas in 5 to 22% of patients. The patches may less frequently develop in toe webs, oral commissures, face, inframammary folds and axilla. Patients may also experience hoarseness and sore throats because of inflammatory involvement of the tonsils, larynx and pharynx.

CNS involvement in the form of meningitis can also be seen in secondary syphilis. It usually occurs during the secondary rash and within the first 6 months of infection, in addition to cranial nerve involvement. Similarly, deafness and optic neuritis may also develop.

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.


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