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Histopathologic features distinguishing secondary syphilis from its mimickers.
J Am Acad Dermatol. 2020 Jan; 82(1):156-160.JA

Abstract

BACKGROUND

Syphilis is often misdiagnosed clinically, and biopsies might be required.

OBJECTIVE

To determine histopathologic features that distinguish secondary syphilis from pityriasis lichenoides (PL), pityriasis rosea (PR), and early mycosis fungoides (MF).

METHODS

Histopathologic features of 100 cases of syphilis, 110 cases of PL, 72 cases of PR, and 101 cases of MF were compared.

RESULTS

Elongated rete ridges and interstitial inflammation favor syphilis over PL (likelihood ratios 3.44 and 2.72, respectively), but no feature reliably distinguishes between them. Secondary syphilis and PR can be distinguished by neutrophils in the stratum corneum, plasma cells, interface dermatitis with lymphocytes and vacuoles, and lymphocytes with ample cytoplasm. Plasma cells and lymphocytes with ample cytoplasm are rare in early MF and can be used as distinguishing features.

CONCLUSIONS

Histopathologic features characteristic of syphilis can be seen in PL, PR, and early MF. Distinguishing syphilis from PL can be difficult histologically, and a high index of suspicion is required. Although elongation of rete and interstitial inflammation favor syphilis, plasma cells (historically considered a significant feature of syphilis) are often encountered in PL. Vacuolar interface dermatitis with a lymphocyte in every vacuole is considered characteristic of PL, but this feature appears to be more common in syphilis.

Authors+Show Affiliations

Department of Pathology and Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania. Electronic address: aflamm@pennstatehealth.psu.edu.Department of Pathology and Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania.Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York.Dermpath Diagnostics New York, Port Chester, New York.Department of Dermatology, University of South Carolina, Charleston, South Carolina.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31306731

Citation

Flamm, Alexandra, et al. "Histopathologic Features Distinguishing Secondary Syphilis From Its Mimickers." Journal of the American Academy of Dermatology, vol. 82, no. 1, 2020, pp. 156-160.
Flamm A, Alcocer VM, Kazlouskaya V, et al. Histopathologic features distinguishing secondary syphilis from its mimickers. J Am Acad Dermatol. 2020;82(1):156-160.
Flamm, A., Alcocer, V. M., Kazlouskaya, V., Kwon, E. J., & Elston, D. (2020). Histopathologic features distinguishing secondary syphilis from its mimickers. Journal of the American Academy of Dermatology, 82(1), 156-160. https://doi.org/10.1016/j.jaad.2019.07.011
Flamm A, et al. Histopathologic Features Distinguishing Secondary Syphilis From Its Mimickers. J Am Acad Dermatol. 2020;82(1):156-160. PubMed PMID: 31306731.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Histopathologic features distinguishing secondary syphilis from its mimickers. AU - Flamm,Alexandra, AU - Alcocer,Veronica Merelo, AU - Kazlouskaya,Viktoryia, AU - Kwon,Eun Ji, AU - Elston,Dirk, Y1 - 2019/07/12/ PY - 2019/02/13/received PY - 2019/05/30/revised PY - 2019/07/08/accepted PY - 2019/7/16/pubmed PY - 2020/7/1/medline PY - 2019/7/16/entrez KW - dermatopathology KW - mycosis fungoides KW - pityriasis lichenoides KW - pityriasis rosea KW - secondary syphilis KW - syphilis SP - 156 EP - 160 JF - Journal of the American Academy of Dermatology JO - J Am Acad Dermatol VL - 82 IS - 1 N2 - BACKGROUND: Syphilis is often misdiagnosed clinically, and biopsies might be required. OBJECTIVE: To determine histopathologic features that distinguish secondary syphilis from pityriasis lichenoides (PL), pityriasis rosea (PR), and early mycosis fungoides (MF). METHODS: Histopathologic features of 100 cases of syphilis, 110 cases of PL, 72 cases of PR, and 101 cases of MF were compared. RESULTS: Elongated rete ridges and interstitial inflammation favor syphilis over PL (likelihood ratios 3.44 and 2.72, respectively), but no feature reliably distinguishes between them. Secondary syphilis and PR can be distinguished by neutrophils in the stratum corneum, plasma cells, interface dermatitis with lymphocytes and vacuoles, and lymphocytes with ample cytoplasm. Plasma cells and lymphocytes with ample cytoplasm are rare in early MF and can be used as distinguishing features. CONCLUSIONS: Histopathologic features characteristic of syphilis can be seen in PL, PR, and early MF. Distinguishing syphilis from PL can be difficult histologically, and a high index of suspicion is required. Although elongation of rete and interstitial inflammation favor syphilis, plasma cells (historically considered a significant feature of syphilis) are often encountered in PL. Vacuolar interface dermatitis with a lymphocyte in every vacuole is considered characteristic of PL, but this feature appears to be more common in syphilis. SN - 1097-6787 UR - https://www.unboundmedicine.com/medline/citation/31306731/Histopathologic_features_distinguishing_secondary_syphilis_from_its_mimickers_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0190-9622(19)32366-7 DB - PRIME DP - Unbound Medicine ER -