Red Rash on Palm: Non-Itchy, Non-Painful, and Syphilis Negative

There are scaly red rashes on the palm that are neither painful nor itchy, but syphilis tests are negative?

Hello Doctor: About two months ago, I had unprotected oral sex where I was the recipient.
Approximately one week after the encounter, I noticed pink, non-painful, non-itchy rashes appearing on my palms.
Over time, the skin has been peeling, and occasionally, areas without rashes also experience circular keratin layer separation and peeling.
This condition has persisted for a month, and it is only present on my palms.
Prior to this, there were no ulcers in the genital or oral areas, and the soles of my feet are completely clear.
I have undergone two comprehensive STD screenings during this period, both of which returned negative results.
However, regarding the lesions on my hands, I found it difficult to find other corresponding results online aside from syphilis, especially since there is no pain or itching, which is quite perplexing to me.

My question is: if I had blood tests for syphilis while the rash was present (with a one-month interval between the two tests) and both reports came back negative, can I be 100% certain that the lesions on my hands are not related to syphilis? If so, what else could be causing the lesions on my hands? Additionally, prior to the onset of the rash, I was also treated for balanitis with a two-week course of amoxicillin.
Could this be a side effect of amoxicillin? However, it has been over a month since I stopped the medication, and the rash continues to develop new spots.
Thank you, Doctor.

Jiao Lv De Yi Kua Rou, 40~49 year old female. Ask Date: 2023/07/31

Dr. Wu Yuxin reply Dermatology

The lesions on the hand could be caused by various factors, and it is necessary to have them examined for a proper diagnosis.
It is recommended to consult a nearby dermatologist for evaluation and treatment.

Reply Date: 2023/07/31

More Info

Hello! Thank you for your question regarding the red rash on your palm. Based on your description, it seems you have been experiencing a persistent pink rash on your palm that is non-itchy and non-painful, along with some peeling skin. You also mentioned that you have tested negative for syphilis twice, which is a good sign in ruling out that particular sexually transmitted infection.

To address your concerns, it is important to note that while syphilis can present with various skin manifestations, the negative test results you received significantly reduce the likelihood that your rash is related to syphilis. However, it is essential to consider other potential causes for your symptoms.

1. Contact Dermatitis: One possibility is contact dermatitis, which can occur due to exposure to irritants or allergens. This condition may not always present with itching or pain, especially in cases of irritant contact dermatitis. If you have come into contact with any new soaps, detergents, or other substances, this could be a contributing factor.

2. Psoriasis: Another potential cause could be psoriasis, a chronic autoimmune condition that can lead to red patches of skin covered with thick, silvery scales. While psoriasis typically itches, some individuals may experience it differently. The peeling skin you described could be indicative of this condition.

3. Fungal Infections: Fungal infections, such as tinea manuum (a fungal infection of the hand), can also cause red, scaly patches that may not be itchy. These infections can sometimes be mistaken for other skin conditions.

4. Drug Reactions: You mentioned taking amoxicillin for a penile glans infection. While it is less common, some individuals can develop drug rashes as a reaction to medications. These rashes can sometimes appear after the medication has been stopped. However, since your rash has persisted for over a month, it is less likely to be solely related to the antibiotic.

5. Other Dermatological Conditions: Other skin conditions, such as eczema or even a viral exanthem, could also be responsible for your symptoms.
Given that your rash has persisted for over two months and is accompanied by new lesions, it is advisable to consult a dermatologist for a thorough evaluation. They may recommend a skin biopsy or other diagnostic tests to determine the exact cause of your rash.
In the meantime, avoid any known irritants, maintain good hand hygiene, and consider using a gentle moisturizer to help with the peeling skin. If you notice any changes in the rash, such as increased redness, swelling, or the development of blisters, seek medical attention promptly.

In summary, while your negative syphilis tests are reassuring, it is essential to explore other potential causes for your palm rash. A dermatologist will be best equipped to provide you with a definitive diagnosis and appropriate treatment options. Thank you for your question, and I wish you the best in resolving your skin concerns!

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