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Can ringworm be confused with the Syphilis Rash?

Jan 2014
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Practicing since : 2002
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Can ringworm be confused with the Syphilis Rash? I heard that Pityriasis Rosea, Ringworm & Syphilis all have similar looking rashes. Let me back track a bit: A few weeks-month ago I had a small circular flaky skin on chest that went away on its own. Then, another similar red flaky circle appeared on my neck which i thought was a sign of Ringworm. I had ringworm a couple years before and still had a tube of Ketoconazole cream left over so i started to apply this cream (which expired last year). I called my P.C.P. to set an appointment and just a few days before my visit when i took a hot shower i noticed red bumps appearing on my chest and stomach and also on my upper back and spine region. When i wore a scarf to hide the circle i noticed more bumps appearing on my neck. The doctor diagnosed this as a reaction from the ringworm and the steroid cream i was using so she told me to go pick up some anti fungal cream. The first few days of using the cream it seemed to help the itching but last night the itching was worse and my scratching seemed to irritate it more. I took a blood test a day after my visit with the doctor so i am hoping that will rule out syphilis. I have been with the same partner for 2 years. I set an appointment with a dermatologist for next week and i am hoping they can help, but in the meantime i am so itchy! Could this be a sign of Pityriasis Rosea? I only have one ring shaped rash and everything else are just red rash like bumps. They do not look like sores. Please help. Thank you
Posted Thu, 2 Jan 2014 in Skin Hair and Nails
Answered by Dr. Kakkar S. 33 minutes later
Brief Answer: ?Pityriasis Rosea ?Syphilis Detailed Answer: Hi. Thanks for posting your concern at XXXXXXX Pityriasis Rosea classically begins with a Herald patch(Mother patch) which is a large circular or oval patch on trunk or extremities commonly. It is usually single but may be two patches on body. It might be confused with ringworm. This is followed 2-4 weeks later by a crop (multiple cycles of crops may last 2-4 weeks) of lesions on trunk and extremities. They are round or oval patches with very fine scaling (cigarette paper like scaling) that is adherent at the periphery and loose centrally. They might be arranged classically in a christmus-tree pattern on the back. Pityriasis Rosea is a reaction pattern to various infections (viral infections like herpes have been implicated), drugs etc. Syphilis is a great imitator. Syphilis rash is one of the differential diagnosis of Pityriasis Rosea. *A useful distinguishing feature of syphilis is that the rash of syphilis characteristically involves the palms and soles. A blood test for syphilis will confirm or rule it out. Looking at the pictures you sent it seems that the patch on the center of your neck looks to me like a Herald patch(Mother patch). The rash on the sides of your neck looks like part of a crop that may have appeared later with similar lesions on the back and trunk (Oval patches with their long axis oriented diagonally). Yes, but i would have kept a differential of syphilis since i did'nt get the opportunity to examine your palms and soles. A blood test like VDRL Would confirm or rule out syphilis. Syphilis rash is usually not that itchy. Also in syphilis their are palpable nodes in the neck, groin, and classically elbow(epitrochlear) Pityriasis Rosea is self limiting. As a treating doctor i usually prescribe a moderately potent steroid like mometasone for topical application for 2-4 weeks. Sometimes people develop new crops of lesions but that usually stops by itself. An oral antihistamine would help you with the itch part. Hope this information helps take care
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Follow-up: Can ringworm be confused with the Syphilis Rash? 1 hour later
Thank you for such a quick response. In regards to ruling out syphilis. I do not have any markings on palms or soles and do not appear to have any swollen lymph nodes. Do you know by chance if the anti-fungal cream would irritate the rash more if it was Pityriasis Rosea and not Ringworm? It seems after using the anti fungal cream for 4 days now that it is making them more red. Thank you.
Answered by Dr. Kakkar S. 9 hours later
Brief Answer: Topical steroids+oral erythromycin Detailed Answer: Hi. thanks for the additional information. I would still advice a blood test to rule out syphilis. Pityriasis rosea is indeed a very close differential of syphilis!! Antifungal creams won't benefit Pityriasis Rosea at all. In addition it may or may not cause irritation but it won't benefit in pityriasis rosea. As a treating doctor i usually prescribe a moderately potent steroid like mometasone for topical application for 2-4 weeks. Studies have also shown a role of oral erythromycin 250mg QID for 10-14 days. I usually prescribe it in my patients of Pityriasis Rosea. You might get breakthough episodes/crops of new lesions but that usually stops once you are on treatment. I would advice that you visit a dermatologist for a prescription for these. take care regards
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