Correspondence

Correction

Keratoderma Blennorrhagicum–like Rash

N Engl J Med 2008; 359:974August 28, 2008

Article

To the Editor:

Tonna and Laing (May 15 issue)1 describe a patient with secondary syphilis. I question the authors' use of the term “keratoderma blennorrhagica,” which are the psoriasiform and vesicular pustular lesions of the palms and soles seen in Reiter's syndrome, along with symptoms involving the joints, eyes, and urinary tract. Although similar, the lesions depicted in this Image in Clinical Medicine appear to be the typical symmetric papules and plaques with collarette scales (i.e., Biett collarettes) seen on the palms and soles in secondary syphilis. The lesions shown appear to be classic and pathognomonic for secondary syphilis.

Peter C. Lombardo, M.D.
Columbia University College of Physicians and Surgeons, New York, NY 10022

1 References

1. 1

   Tonna I, Laing RBS. Keratoderma blennorrhagica. N Engl J Med 2008;358:2160-2160
   Full Text | Medline

Author/Editor Response

We agree with Lombardo that the term “keratoderma blennorrhagicum” is often used in conjunction with Reiter's syndrome. However, syphilis can mimic a number of conditions, and as Lombardo suggests, the lesions look similar to keratoderma. We wanted to make the point that when someone presents with such a rash on the soles, the differential diagnosis should include secondary syphilis.

Ivan Tonna, M.R.C.P.
Robert B.S. Laing, M.D.
Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, Scotland