Syphilis of the center of the face has been known for many years, but few instances of its occurrence have been reported. The condition probably is rare. Church1 stated that 1 in every 10,000 persons in this country is affected. Diday2 carefully described it in 1883.
Lacapère,3 in an interesting and inclusive monograph on syphilis in North African natives in 1922, reported that secondary syphilis is rarely seen in the natives but rather destructive tertiary-like transitional processes are seen frequently. Lacapère, like Fournier, called these "secondotertiary lesions." They are ulcerative and necrotic gummatous-like processes and apparently occur as a result of infection with an attenuated strain of syphilitic "virus" due to involvement in generation after generation without treatment. These syphilids usually are superficial and frequently are papular or vegetating.
The secondotertiary types are localized on the face, on the back of the neck, on the lower extremities
COLE HN, DRIVER JR, FREEMAN HE. SYPHILIS OF THE CENTER OF THE FACE. Arch Derm Syphilol. 1941;43(6):943–948. doi:10.1001/archderm.1941.01490240023003
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