Macular syphilide (roseolar rash) is the earliest syphilide and appears like symmetrical, round or oval coppery-red macules, nonpruritic, nonscaling, on the trunk and on the inner surfaces of the extremities.
Secondary syphilides can mimick a lot of dermatological diseases, from exantema to acne and even psoriasis.
Papular syphilides are nonpruritic, round or oval papules, 3 mm in diameter.
Papular syphilides tend to be disseminated but may also be localized, asymmetrical, configurate, confluent, etc.--arranged in figures as they are: patches, rings, serpiginous, corymbose (a large central papule surrounded by a group of minute satellite papules).
The secondary syphilides may appear like any dermatological diseases, such as lichen planus, psoriasis, parapsoriasis, seborrheic dermatitis, acne vulgaris, impetigo, scabies, condylomata acuminata, etc--all of this making the clinical diagnosis quite difficult.
They are represented by nodular or tubercular syphilides, which most often occur 3 to 5 years after infection.
Early congenital syphilis emerges in the first two years of life, and skin lesions are much like the secondary syphilides from the acquired syphilis: papular, papuloscuamous syphilides, deeply fissured papules of the mouth angles or the nostrils, condylomata lata (usually in the first year, hardly in the newborn period), pemphigus syphiliticus: bullae on the red infiltrated base, localized on the palms and soles, with rupture and leaving exuding areas.