{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:11:03Z","timestamp":1781842263189,"version":"3.54.5"},"reference-count":15,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2014,9,10]],"date-time":"2014-09-10T00:00:00Z","timestamp":1410307200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pustular syphilis is an extremely rare manifestation of secondary syphilis. Failure to recognize the disease can have devastating consequences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We present three patients with pustular syphilis as the primary manifestation of secondary syphilis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patient 1 was initially diagnosed by <jats:styled-content style=\"fixed-case\">V<\/jats:styled-content>enereal <jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>isease <jats:styled-content style=\"fixed-case\">R<\/jats:styled-content>esearch <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>aboratory (<jats:styled-content style=\"fixed-case\">VDRL<\/jats:styled-content>) test (titers 1\u00a0:\u00a032) and confirmed by enzyme immunoassay (<jats:styled-content style=\"fixed-case\">EIA<\/jats:styled-content>) for <jats:italic><jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>reponema pallidum<\/jats:italic>. Patient 2 was screened for syphilis by <jats:styled-content style=\"fixed-case\">VDRL<\/jats:styled-content> (titers 1\u00a0:\u00a064), yielding a positive result, and tested negative for <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>. Secondary syphilis was confirmed by <jats:styled-content style=\"fixed-case\">EIA<\/jats:styled-content>. In Patient 3, a diagnosis of secondary syphilis was established by <jats:styled-content style=\"fixed-case\">VDRL<\/jats:styled-content> (titers 1\u00a0:\u00a0128) and <jats:styled-content style=\"fixed-case\">EIA<\/jats:styled-content>. <jats:italic><jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>reponema pallidum<\/jats:italic> was detected by dark field microscopy in three patients. Testing for <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> infection was negative in all patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Diagnosis in secondary syphilis remains challenging because of the diversity of clinical presentations. The most commonly observed cutaneous presentation is a generalized, non\u2010pruritic, papulosquamous eruption varying from pink to violaceous to brown, with mucous membrane involvement. The diagnostic methods used to identify secondary syphilis are the same as those used to diagnose other stages of syphilitic infection. The persistence of syphilis in both developed and underdeveloped regions highlights the importance of considering syphilitic infection in the setting of a cutaneous pustular eruption, especially one that fails to respond to standard therapy. Testing for other sexually transmitted diseases, including <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>, should be performed in all patients diagnosed with syphilis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijd.12337","type":"journal-article","created":{"date-parts":[[2014,9,11]],"date-time":"2014-09-11T02:54:48Z","timestamp":1410404088000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Pustular secondary syphilis: report of three cases and review of the literature"],"prefix":"10.1111","volume":"53","author":[{"given":"Viktoryia","family":"Kazlouskaya","sequence":"first","affiliation":[{"name":"Ackerman Academy of Dermatopathology New York NY USA"},{"name":"Department of Dermatovenereology Gomel State Medical University Gomel Belarus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christa","family":"Wittmann","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Lenox Hill Hospital New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iryna","family":"Tsikhanouskaya","sequence":"additional","affiliation":[{"name":"Department of Dermatovenereology Vitebsk State Medical University Vitebsk Belarus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,9,10]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/00015550510030078"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.4103\/0378-6323.48682"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1258\/0956462011924038"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp048126"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007435-198010000-00002"},{"key":"e_1_2_5_7_1","first-page":"8","article-title":"Pustular secondary syphilis: a study of twenty\u2010one cases","volume":"3","author":"Siddappa K","year":"1982","journal-title":"Indian J Sex Transm Dis"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1086\/594127"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1258\/ijsa.2012.011413"},{"key":"e_1_2_5_10_1","first-page":"459","article-title":"Pustular secondary syphilis","volume":"50","author":"Miller RL","year":"1974","journal-title":"Br J Vener Dis"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.1969.01610280089017"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4362.1987.tb00537.x"},{"key":"e_1_2_5_13_1","first-page":"69","article-title":"Pustular acneiform secondary syphilis","volume":"37","author":"Lambert WC","year":"1986","journal-title":"Cutis"},{"key":"e_1_2_5_14_1","first-page":"25","article-title":"Early varioliform syphilis. A case report","volume":"57","author":"Lejman K","year":"1981","journal-title":"Br J Vener Dis"},{"key":"e_1_2_5_15_1","first-page":"67","article-title":"Case of ecthymiform and rupioid syphilid","volume":"10","author":"Zui GI","year":"1981","journal-title":"Vestn Dermatol Venerol"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/DAD.0b013e3181e8b587"}],"container-title":["International Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fijd.12337","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijd.12337","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T08:30:22Z","timestamp":1696321822000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ijd.12337"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,9,10]]},"references-count":15,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2014,10]]}},"alternative-id":["10.1111\/ijd.12337"],"URL":"https:\/\/doi.org\/10.1111\/ijd.12337","archive":["Portico"],"relation":{},"ISSN":["0011-9059","1365-4632"],"issn-type":[{"value":"0011-9059","type":"print"},{"value":"1365-4632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,9,10]]},"assertion":[{"value":"2014-09-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}