Which rash distribution is classic for secondary syphilis?

• A. Maculopapular rash on trunk
• B. Maculopapular rash including palms and soles
• C. Vesicular rash on mucous membranes
• D. Petechial rash on legs

Answer: (B)

Secondary syphilis most often presents with a diffuse, symmetric maculopapular eruption that includes the palms and soles. That palm and sole involvement is a distinctive feature that helps set this stage apart from many other rashes, which typically spare those areas. The eruption may be accompanied by mucous patches, condylomata lata, fever, and lymphadenopathy. A rash confined to the trunk lacks that characteristic palmar/plantar distribution, while vesicular lesions on mucous membranes and petechial rashes on the legs are not typical for secondary syphilis.