{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:43:12Z","timestamp":1787244192435,"version":"build-2736575974"},"reference-count":81,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T00:00:00Z","timestamp":1673395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Syphilis is characterized by a wide range of variable clinical symptoms; therefore, it is often referred to as \u201cThe Great Imitator\u201d. Here, we report the case of a 69-year-old hepatitis-C-positive MSM patient, who was admitted to our clinic due to a solitary firm painless erythematous maculopapular lesion with a central crater-like crust on the upper right thigh that occurred two months prior. The dermoscopy showed an erythematous, copper-colored, oval lesion with diffuse monomorphic dotted and glomerular vessels, central crust, and circular scaling (Biett\u2019s sign). The histological findings ruled out neoplasia and described a plasma cell infiltrate and endothelial swelling. Finally, the combination of the dermoscopic image, histological findings and the additionally acquired knowledge about the sexual history of the patient at the second visit led to the diagnosis, which was then confirmed with serological tests. Dermoscopy may become a supportive tool to facilitate the recognition of secondary syphilis; however, the reporting of these atypical cases is crucial to highlight the many faces of the disease so that clinicians consider syphilis as part of the differential diagnosis of non-specific lesions.<\/jats:p>","DOI":"10.3390\/ijerph20021339","type":"journal-article","created":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T01:32:26Z","timestamp":1673487146000},"page":"1339","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Syphilis, the Great Imitator\u2014Clinical and Dermoscopic Features of a Rare Presentation of Secondary Syphilis"],"prefix":"10.3390","volume":"20","author":[{"given":"Carmen","family":"Cantisani","sequence":"first","affiliation":[{"name":"Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, \u201cSapienza Medical School\u201d University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Rega","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, \u201cSapienza Medical School\u201d University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6312-7709","authenticated-orcid":false,"given":"Luca","family":"Ambrosio","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, \u201cSapienza Medical School\u201d University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7855-6621","authenticated-orcid":false,"given":"Teresa","family":"Grieco","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, \u201cSapienza Medical School\u201d University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9947-1755","authenticated-orcid":false,"given":"Norbert","family":"Kiss","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanni Ad\u00e9l","family":"Meznerics","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e1s","family":"B\u00e1nv\u00f6lgyi","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giordano","family":"Vespasiani","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, \u201cSapienza Medical School\u201d University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Arienzo","sequence":"additional","affiliation":[{"name":"Department of Radiological, Oncological and Pathological Sciences, \u201cSapienza Medical School\u201d University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Rossi","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, \u201cSapienza Medical School\u201d University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Soda","sequence":"additional","affiliation":[{"name":"Department of Radiological, Oncological and Pathological Sciences, \u201cSapienza Medical School\u201d University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Pellacani","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, \u201cSapienza Medical School\u201d University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,11]]},"reference":[{"key":"ref_1","first-page":"639","article-title":"Epidemiology of sexually transmitted diseases: The global picture","volume":"68","author":"Meheus","year":"1990","journal-title":"Bull. World Health Organ."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s12978-019-0815-5","article-title":"Prevalence of sexually transmitted infections and associated factors among the University of Gondar students, Northwest Ethiopia: A cross-sectional study","volume":"16","author":"Kassie","year":"2019","journal-title":"Reprod. Health"},{"key":"ref_3","first-page":"11","article-title":"The Presentation, Diagnosis, and Treatment of Sexually Transmitted Infections","volume":"113","author":"Wagenlehner","year":"2016","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1056\/NEJMra1411426","article-title":"Pelvic inflammatory disease","volume":"372","author":"Brunham","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Olusola, P., Banerjee, H.N., Philley, J.V., and Dasgupta, S. (2019). Human Papilloma Virus-Associated Cervical Cancer and Health Disparities. Cells, 8.","DOI":"10.3390\/cells8060622"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1016\/S0025-7125(16)30498-9","article-title":"Sexually transmitted arthritis syndromes","volume":"74","author":"Keat","year":"1990","journal-title":"Med. Clin. N. Am."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e20152387","DOI":"10.1542\/peds.2015-2387","article-title":"Infant Deaths Due To Herpes Simplex Virus, Congenital Syphilis, and HIV in New York City","volume":"137","author":"Sampath","year":"2016","journal-title":"Pediatrics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e13039","DOI":"10.1111\/aji.13039","article-title":"Does per-act HIV-1 transmission risk through anal sex vary by gender? An updated systematic review and meta-analysis","volume":"80","author":"Baggaley","year":"2018","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1093\/ije\/dyq057","article-title":"HIV transmission risk through anal intercourse: Systematic review, meta-analysis and implications for HIV prevention","volume":"39","author":"Baggaley","year":"2010","journal-title":"Int. J. Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e25355","DOI":"10.1002\/jia2.25355","article-title":"Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: The biologic basis for epidemiologic synergy","volume":"22","author":"Cohen","year":"2019","journal-title":"J. Int. AIDS Soc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1542\/peds.2009-0674","article-title":"Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States","volume":"124","author":"Forhan","year":"2009","journal-title":"Pediatrics"},{"key":"ref_12","first-page":"1","article-title":"Sexually transmitted diseases treatment guidelines, 2015","volume":"64","author":"Workowski","year":"2015","journal-title":"MMWR Recomm. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10461-007-9299-3","article-title":"Estimating HIV prevalence and risk behaviors of transgender persons in the United States: A systematic review","volume":"12","author":"Herbst","year":"2008","journal-title":"AIDS Behav."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1093\/cid\/civ778","article-title":"No New HIV Infections With Increasing Use of HIV Preexposure Prophylaxis in a Clinical Practice Setting","volume":"61","author":"Volk","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e25164","DOI":"10.1002\/jia2.25164","article-title":"HIV and sexually transmitted infections: Responding to the \u201cnewest normal\u201d","volume":"21","author":"Mayer","year":"2018","journal-title":"J. Int. AIDS Soc."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"L\u0151rincz, K., Meznerics, F.A., Jobb\u00e1gy, A., Kiss, N., Madar\u00e1sz, M., Belvon, L., T\u00f3th, B., Tam\u00e1si, B., Wikonk\u00e1l, N.M., and Marschalk\u00f3, M. (2022). STIs during the COVID-19 Pandemic in Hungary: Gonorrhea as a Potential Indicator of Sexual Behavior. Int. J. Environ. Res Public Health, 19.","DOI":"10.3390\/ijerph19159627"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"adv00795","DOI":"10.2340\/actadv.v102.3401","article-title":"Impact of COVID-19 Pandemic on the Incidence of Sexually Transmitted Infections in Northern Finland in 2019 to 2022","volume":"102","author":"Sinikumpu","year":"2022","journal-title":"Acta Dermatol. Venereol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e766","DOI":"10.1111\/jdv.16808","article-title":"STIs and the COVID-19 pandemic: The lockdown does not stop sexual infections","volume":"34","author":"Balestri","year":"2020","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1016\/S0140-6736(16)32411-4","article-title":"Syphilis","volume":"389","author":"Hook","year":"2017","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S88","DOI":"10.1097\/OLQ.0000000000001449","article-title":"Scientific and Programmatic Gaps in STD Prevention: A 2020 Assessment","volume":"48","author":"Leichliter","year":"2021","journal-title":"Sex. Transm. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Jobb\u00e1gy, A., Kiss, N., Meznerics, F.A., Farkas, K., Pl\u00e1z\u00e1r, D., Bozs\u00e1nyi, S., F\u00e9s\u0171s, L., Bartha, \u00c1., Szab\u00f3, E., and L\u0151rincz, K. (2022). Emergency Use and Efficacy of an Asynchronous Teledermatology System as a Novel Tool for Early Diagnosis of Skin Cancer during the First Wave of COVID-19 Pandemic. Int. J. Environ. Res Public Health, 19.","DOI":"10.3390\/ijerph19052699"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.ijwd.2020.09.010","article-title":"Impact of COVID-19 pandemic on dermatology practices: Results of a web-based, global survey","volume":"7","author":"Bhargava","year":"2021","journal-title":"Int. J. Womens Dermatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e772","DOI":"10.1111\/jdv.16843","article-title":"A survey on teledermatology use and doctors\u2019 perception in times of COVID-19","volume":"34","author":"Moscarella","year":"2020","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_24","unstructured":"(2022). Sexually Transmitted Disease Surveillance 2020."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.2105\/AJPH.2011.300383","article-title":"Repeat syphilis among men who have sex with men in California, 2002-2006: Implications for syphilis elimination efforts","volume":"102","author":"Cohen","year":"2012","journal-title":"Am. J. Public Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jaad.2019.02.073","article-title":"Sexually acquired syphilis: Historical aspects, microbiology, epidemiology, and clinical manifestations","volume":"82","author":"Forrestel","year":"2020","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1007\/s11524-012-9766-7","article-title":"Epidemiology, sexual risk behavior, and HIV prevention practices of men who have sex with men using GRINDR in Los Angeles, California","volume":"90","author":"Landovitz","year":"2013","journal-title":"J. Urban Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1097\/01.olq.0000168280.34424.58","article-title":"Risk factors for early syphilis among gay and bisexual men seen in an STD clinic: San Francisco, 2002\u20132003","volume":"32","author":"Wong","year":"2005","journal-title":"Sex. Transm. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1038\/nrmicro.2016.141","article-title":"Treponema pallidum, the syphilis spirochete: Making a living as a stealth pathogen","volume":"14","author":"Radolf","year":"2016","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1126\/science.281.5375.375","article-title":"Complete genome sequence of Treponema pallidum, the syphilis spirochete","volume":"281","author":"Fraser","year":"1998","journal-title":"Science"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jaad.2019.02.074","article-title":"Sexually acquired syphilis: Laboratory diagnosis, management, and prevention","volume":"82","author":"Forrestel","year":"2020","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"17073","DOI":"10.1038\/nrdp.2017.73","article-title":"Syphilis","volume":"3","author":"Peeling","year":"2017","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1128\/CMR.12.2.187","article-title":"Syphilis: Review with emphasis on clinical, epidemiologic, and some biologic features","volume":"12","author":"Singh","year":"1999","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.clindermatol.2005.01.015","article-title":"Syphilis: Uncommon presentations in adults","volume":"23","author":"Dourmishev","year":"2005","journal-title":"Clin. Dermatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1111\/ijd.12518","article-title":"The great imitator revisited: The spectrum of atypical cutaneous manifestations of secondary syphilis","volume":"53","author":"Balagula","year":"2014","journal-title":"Int. J. Dermatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1111\/j.1365-2133.2005.06546.x","article-title":"Extensive annular verrucous late secondary syphilis","volume":"152","author":"Pournaras","year":"2005","journal-title":"Br. J. Dermatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1001\/archderm.144.8.1078","article-title":"Extensive nodular secondary syphilis with prozone phenomenon","volume":"144","author":"Battistella","year":"2008","journal-title":"Arch. Dermatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/j.1365-4362.1987.tb00537.x","article-title":"Pustular secondary syphilis","volume":"26","author":"Noppakun","year":"1987","journal-title":"Int. J. Dermatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1136\/sti.66.2.99","article-title":"Secondary syphilis with framboesiform lesions","volume":"66","author":"Tham","year":"1990","journal-title":"Sex. Transm. Infect."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/BF01997847","article-title":"Syphilis maligna","volume":"38","author":"Haslund","year":"1897","journal-title":"Arch. Dermatol. Syph."},{"key":"ref_41","first-page":"11","article-title":"Malignant syphilis","volume":"9","author":"Neisser","year":"1897","journal-title":"Br. J. Dermatol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1128\/CMR.8.1.1","article-title":"Laboratory diagnosis and interpretation of tests for syphilis","volume":"8","author":"Larsen","year":"1995","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e0010021","DOI":"10.1128\/JCM.00100-21","article-title":"The Laboratory Diagnosis of Syphilis","volume":"59","author":"Satyaputra","year":"2021","journal-title":"J. Clin. Microbiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1093\/cid\/ciy558","article-title":"Performance of Treponemal Tests for the Diagnosis of Syphilis","volume":"68","author":"Park","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1111\/jdv.16946","article-title":"2020 European guideline on the management of syphilis","volume":"35","author":"Janier","year":"2021","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1177\/095646249100200411","article-title":"Primary and secondary syphilis: A histopathological study","volume":"2","author":"Engelkens","year":"1991","journal-title":"Int. J. STD AIDS"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/00000372-198302000-00004","article-title":"Secondary syphilis. Clinical morphology and histopathology","volume":"5","author":"Alessi","year":"1983","journal-title":"Am. J. Dermatol."},{"key":"ref_48","first-page":"399","article-title":"Secondary syphilis. A clinicopathological study","volume":"10","author":"Jordaan","year":"1988","journal-title":"Am. J. Dermatol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1001\/archderm.1973.01620180027008","article-title":"Histologic patterns of secondary syphilis","volume":"107","author":"Jeerapaet","year":"1973","journal-title":"Arch. Dermatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1111\/j.0303-6987.2004.00236.x","article-title":"Secondary syphilis: A histologic and immunohistochemical evaluation","volume":"31","author":"Hoang","year":"2004","journal-title":"J. Cutan. Pathol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.det.2007.12.001","article-title":"Syphilis: The international challenge of the great imitator","volume":"26","author":"Handog","year":"2008","journal-title":"Dermatol. Clin."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1503\/cmaj.060665","article-title":"The rash of secondary syphilis","volume":"176","author":"Dylewski","year":"2007","journal-title":"Cmaj"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"270","DOI":"10.4103\/0378-6323.196318","article-title":"Dermoscopy of Biett\u2019s sign and differential diagnosis with annular maculo-papular rashes with scaling","volume":"83","author":"Tognetti","year":"2017","journal-title":"Indian J. Dermatol. Venereol. Leprol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1001\/jama.2014.13259","article-title":"Treatment of syphilis: A systematic review","volume":"312","author":"Clement","year":"2014","journal-title":"Jama"},{"key":"ref_55","first-page":"1","article-title":"Sexually transmitted diseases treatment guidelines, 2010","volume":"59","author":"Workowski","year":"2010","journal-title":"MMWR Recomm. Rep."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.jaad.2018.07.073","article-title":"Dermoscopy and dermatopathology correlates of cutaneous neoplasms","volume":"80","author":"Braun","year":"2019","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"130","DOI":"10.3322\/canjclin.35.3.130","article-title":"Early detection of malignant melanoma: The role of physician examination and self-examination of the skin","volume":"35","author":"Friedman","year":"1985","journal-title":"CA Cancer J. Clin."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1001\/jama.279.9.696","article-title":"The rational clinical examination. Does this patient have a mole or a melanoma?","volume":"279","author":"Whited","year":"1998","journal-title":"Jama"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1111\/j.1365-2133.2005.06983.x","article-title":"Three-point checklist of dermoscopy: An open internet study","volume":"154","author":"Zalaudek","year":"2006","journal-title":"Br. J. Dermatol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"169","DOI":"10.5826\/dpc.0903a01","article-title":"Dermoscopy of Inflammatory Dermatoses (Inflammoscopy): An Up-to-Date Overview","volume":"9","author":"Errichetti","year":"2019","journal-title":"Dermatol. Pract. Concept."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1007\/s13555-016-0141-6","article-title":"Dermoscopy in General Dermatology: A Practical Overview","volume":"6","author":"Errichetti","year":"2016","journal-title":"Dermatol. Ther."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1111\/bjd.18125","article-title":"Standardization of dermoscopic terminology and basic dermoscopic parameters to evaluate in general dermatology (non-neoplastic dermatoses): An expert consensus on behalf of the International Dermoscopy Society","volume":"182","author":"Errichetti","year":"2020","journal-title":"Br. J. Dermatol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1111\/bjd.12685","article-title":"Dermoscopy in general dermatology: Practical tips for the clinician","volume":"170","author":"Lallas","year":"2014","journal-title":"Br. J. Dermatol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.det.2013.06.008","article-title":"Dermoscopy in general dermatology","volume":"31","author":"Lallas","year":"2013","journal-title":"Dermatol. Clin."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/j.jaad.2010.03.010","article-title":"Dermatoscopy: Alternative uses in daily clinical practice","volume":"64","author":"Micali","year":"2011","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1002\/ccr3.1999","article-title":"Dermoscopic clues in the skin lesions of secondary syphilis","volume":"7","author":"Mathur","year":"2019","journal-title":"Clin. Case Rep."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1177\/0956462417714178","article-title":"Dermoscopy in differentiating palmar syphiloderm from palmar papular psoriasis","volume":"28","author":"Errichetti","year":"2017","journal-title":"Int. J. STD AIDS"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1177\/0956462419900092","article-title":"Clinicopathological, dermoscopic, and ultrastructural observation of annular secondary syphilis on the penis","volume":"31","author":"Li","year":"2020","journal-title":"Int. J. STD AIDS"},{"key":"ref_69","first-page":"133","article-title":"Secondary syphilis mimicking tinea cruris in an HIV infected patient: A case report","volume":"38","author":"Yuylana","year":"2021","journal-title":"Pan. Afr. Med. J."},{"key":"ref_70","first-page":"8830","article-title":"Psoriasiform syphilis: A challenge","volume":"13","author":"Schettini","year":"2021","journal-title":"Dermatol. Rep."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"E1384","DOI":"10.1503\/cmaj.190469","article-title":"Syphilis imitating urticarial vasculitis","volume":"191","author":"Miyachi","year":"2019","journal-title":"Cmaj"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"445","DOI":"10.3889\/oamjms.2017.087","article-title":"Secondary Syphilis Presenting As Palmoplantar Psoriasis","volume":"5","author":"Gianfaldoni","year":"2017","journal-title":"Open Access Maced. J. Med. Sci."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e162","DOI":"10.1111\/ijd.13072","article-title":"Syphilis as \"the great imitator\": A case of impetiginoid syphiloderm","volume":"55","author":"Ramoni","year":"2016","journal-title":"Int. J. Dermatol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1177\/0956462418795590","article-title":"Secondary syphilis masquerading as lupus vulgaris in an HIV-infected patient: A diagnosis suggested by histology","volume":"29","author":"Genovese","year":"2018","journal-title":"Int. J. STD AIDS"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1111\/j.1600-0560.2012.01930.x","article-title":"Syphilis with a lichen planus-like pattern (hypertrophic syphilis)","volume":"39","author":"Nazzaro","year":"2012","journal-title":"J. Cutan. Pathol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1128\/CMR.18.1.205-216.2005","article-title":"Secondary syphilitic lesions","volume":"18","author":"Baughn","year":"2005","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"291","DOI":"10.4103\/idoj.IDOJ_89_19","article-title":"Cluster of Flowers\u2014The Unseen of Syphilis","volume":"11","author":"Ashwini","year":"2020","journal-title":"Indian Dermatol. Online J."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1001\/jamadermatol.2017.2768","article-title":"Corymbiform Lesions in a Young Healthy Man","volume":"153","year":"2017","journal-title":"JAMA Dermatol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1097\/DAD.0000000000000389","article-title":"Solitary Annular Plaque on the Scrotum","volume":"38","year":"2016","journal-title":"Am. J. Dermatol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1097\/CM9.0000000000000807","article-title":"A solitary annular plaque on the jaw: Atypical presentation of secondary syphilis","volume":"133","author":"Wu","year":"2020","journal-title":"Chin. Med. J."},{"key":"ref_81","first-page":"e10774","article-title":"Cutaneous Secondary Syphilis Resembling Non-Melanoma Skin Cancer","volume":"12","author":"Stone","year":"2020","journal-title":"Cureus"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/2\/1339\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:03:19Z","timestamp":1760119399000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/2\/1339"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,11]]},"references-count":81,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["ijerph20021339"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20021339","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,11]]}}}