Pink Scaling Papules and Plaques on the Palms, Soles, Chest, Abdomen, and Extremities

April 2015 in “ Journal of the American Academy of Dermatology ”

Geoffrey F.S. Lim, Kristin D. Hudacek, Saurabh Lodha, Christina Lee Chung, Carrie Ann Cusack

alopecia secondary syphilis benzathine penicillin G rapid plasma reagin test hair loss penicillin

TLDR The woman likely has secondary syphilis, treatable with penicillin.

A 41-year-old woman with a history of epilepsy presented with a 3-week history of a worsening pink, scaling, pruritic rash on her hands, feet, chest, abdomen, and extremities. She initially thought they were bug bites but had no recent outdoor exposure or similar symptoms in her household. She denied systemic symptoms and had not taken any medications recently. The most likely diagnosis was secondary syphilis, with benzathine penicillin G as the first-line treatment. Without treatment, the eruption could resolve in weeks. The rapid plasma reagin test was commonly used for screening, and alopecia was a sign of the secondary stage of the disease.

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