Pustular psoriasis and chameleon syphilis

A 38-year-old refugee from Nigeria presented at our outpatient clinic with itchy skin changes that had been present for three months. These began on the scalp and spread to the entire integument, including the palms, soles, and genitals. The patient had had multiple sexual partners in recent years. He reported no joint pain. His medical history regarding previous illnesses and medications was unremarkable.

A 49-year-old construction worker of Turkish origin with chronic lymphocytic leukemia complained in our outpatient clinic of increasing skin changes on the entire integument, enoral, and palmoplantar. These had been present for 4 months. Infection prophylaxis with cotrimoxazole and acyclovir was being administered irregularly. The patient reported no other medications or allergies. He reported several high-risk sexual encounters in the past year, as well as fatigue and recurrent mild headaches.

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