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

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.