Congenital Syphilis Bulla

Erythematous Newborn Desquamation

Figure 2.62. Desquamation on the palms and soles with no rash or desquamation elsewhere is very suggestive of congenital syphilis. The palms and soles may be fissured and erythematous and, as a result of subcutaneous edema, may have a shiny appearance.

Figure 2.61. Note the desquamation of the palms and soles in a neonate. There were no other dermatologie lesions elsewhere. The VDRL (Venereal Disease Research Laboratory) test showed maternal blood to be reactive with a titer of 1:32 and the infant had a titer of 1:1024- Lesions on die palms and soles should be considered syphilitic until proven odierwise. The spectrum of cutaneous lesions which occur in 30 to 40% of infants with congenital syphilis can be extremely variable. There may be mild desquamation, annular or circinate lesions or vesiculobullous manifestations.

Figure 2.62. Desquamation on the palms and soles with no rash or desquamation elsewhere is very suggestive of congenital syphilis. The palms and soles may be fissured and erythematous and, as a result of subcutaneous edema, may have a shiny appearance.

Figure 2.63. Syphilitic pemphigus showing the large vesiculobullous hemorrhagic lesions on the soles of both feet. These lesions are relatively rare but, especially when seen on the palms and soles, are highly diagnostic of this disease. The lesions may contain a cloudy hemorrhagic fluid that teems with organisms and is highly contagious. With bullous lesions such as these, other dermatologic diagnoses should be excluded (bullous impetigo, epidermolysis bullosa, congenital bullous ichthyosiform erydiroderma, etc.).

Figure 2.64. A close-up of the foot of the same infant as in Figure 2.63 shows both bullae and ulcerated areas on the sole.

Figure 2.64. A close-up of the foot of the same infant as in Figure 2.63 shows both bullae and ulcerated areas on the sole.

Impetigo Bullosa Neonatorum

Figure 2.65. The same infant as in Figure 2.63 had bullae and ulcerations on the palms of both hands. When bullae rupture, they leave a denuded area diat can undergo extensive maceration and crusting. It is unusual to see the bullae at birth as the majority have ruptured in utero.

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