Across the full spectrum of skin tones, lesions of secondary syphilis can be differentiated from dyshidrosis by lack of involvement of interdigital surfaces. It also differs from tinea manuum by the lack of annular configuration, increased number of lesions, and smaller papular size of lesions with notable collarettes of scale.

Notice the presence of copper-colored papules with collarettes of scale or thick overlying scale on the feet and hands. This feature helps distinguish secondary syphilis from tinea pedis. In darker skin tones, lesions may appear more red to brown in color with dusky background erythema.

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