TABLE 2.

Characteristics of late secondary lesions

Type of lesionCharacteristic appearanceDistribution on the bodyDifferential diagnosis
Large PapularMuch like the small papular variety except that they then to be flattened, although distinctly elevated and less round. Marked tendency toward grouping and plaque formation. Seldom crowded together; often sparsely scattered. May coalesce to form lesions suggestive of tuberculids.May appear on any part of the body. Predilection for the forehead, face, back of the neck, limb bends, and inner thighs.Psoriasis, pityriasis, keratosis, variola, pityriasis lichenoides chronica, lichen planus, papulonecrotic tuberculid, urticaria pigmentosa, nodular leprosy, mycosis fungoides, erythema multiforme, and adenoma sebaceum.
AnnularPapular syphilids which have a circinate configuration. One form appears to develop from a single papule, spreading peripherally and forming a ring or taking the form of gyrate patches. A number of papules may unite to form a hollow or solid ring, giving rise to the second type. Usually annular are sparsely distributed.May appear on any part of the body. Predilection for the mucocutaneous junction of the nasal alae and the oral comissures. Usually not on the limbs. Unusual in Caucasians.Tinea corporis, seborrheic dermatitis (annular type), impetigo contagiosa, pityriasis rosea, erythema multiforme, granuloma annulare, chronic urticaria, and psoriasis.
Condylomata lataThese begin as ordinary papules which become flattened, macerated, and covered with a thick, tenancious, mucoid exudate. Like annular syphilids, they appear in two forms; one is a flat, moist papule varying in size but excoriated in the center, and the elevated (verrucous) or cauliflower type is large, not excoriated, and grayish in appearance and has a vile odor.Most frequently occur around the rectum, on the scrotum and vulva, as well as in the groin.Verruca vulgaris, lymphogranuloma inguinale, granuloma inguinale, intertriginous (mycotic) dermatitis, lichen planus, pyodermia, aphthae, pemphigus, epithelioma, and tuberculosis.
PustularThe typical pustule is indolent, originating as a vesicle. Initially the lesion resembles a papule covered with scales. It then becomes flaccid and ruptures. If a scab forms, beneath it is a punched-out ulcer surrounded by a slight inflammatory arcola, usually with a livid or bluish tingue. These contain very little pus and tend to group into gyrate configurations. If no scab forms, the unencrusted lesions simply appear as punched-out ulcerations.May appear on any part of the body. Predilection for the face, especially the nose, the flanks and thighs, the palms of the hands, and the soles of the feet.Variola, pyodermia, acne serofulosorum and cachecticorum, ecthyma, acne necrotica, papulonecrotic tuberculids, acne varioliformis, psoriasis, tineal (corporis) dermatitis, dermatitis medicamentosa, impetigo contagiosa, and acne vulgaris.
RupialReally large pustules which have piled-up crusts. These are typically an encrusted, impetiginous eruption without an inflammatory areola.May appear on any part of the body.Variola, pyodermia, acne scrofulosorum and cachecticorum, ecthyma, acne necrotica, papulonecrotic tuberculids, acne varioliformis, psoriasis, tineal (corporis) dermatitis, dermatitis medicamentosa, impetigo contagiosa, and acne vulgaris.
FrambesiformA hypertrophic type of papular lesion characterized by raspberrylike growths of various shapes and sizes. These lesions are moist, violaceous, and softly verrucous with a high serous content and an offensive odor.May appear on any part of the body. Predilection for the face and scalp, especially the mouth or nose. Also found in the axilla or the anal and genital regions.Fungating condylomas.
PigmentaryThese lesions vary in size and are not raised above the skin's surface. They may be hypopigmented (depigmented) or hyperpigmented.May appear on any part of the body. Predilection for the arms and trunk.Vitiligo, dermatitis medicamentosa, tinea versicolor, xeroderma pigmentosum, erythema aboigne, factitial dermatitis, scleroderma, leprosy, chloasma, residual inflammatory dermatitis, and pigmented scars.