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REITER SYNDROME, KERATODERMA, BLENNORRHAGICUM, AND CIRCINATE BALANITIS

Reiter syndrome consists of arthropathy, iritis, urethritis, and skin lesions (Figs 7.28 and 7.29). It is typically provoked by non-gonococcal urethritis or by bowel infection with Yersinia or other organisms. The urethritis pattern has a strong male predominance. Patients are often HLA-B27- positive, and a similar pattern of skin lesions can occur with axial arthritis in the absence of an overt infective trigger.

Figure. 7.29 Reiter syndrome. ( a , b ) Examples of lesions on the soles; these annular lesions are typical of keratoderma blennorrhagicum.

    The skin lesions consist of localized patches of plantar psoriasiform hyperkeratosis, and penile patches that may form a characteristic circinate balanitis (Fig.7.30). Psoriasiform lesions may occur at other body sites, especially digits and nails. Like psoriasis, Reiter syndrome may be particularly severe in HIV infection. However, the 10-fold increased frequency of Reiter syndrome in homosexual or bisexual men may be related to other infections, as it does not appear to be specific to HIV status.

Figure. 7.30 Reiter syndrome. Circinate balanitis, with urethral discharge. (Courtesy of Dr. B. Stanley.)

    The main differential diagnosis, if the trigger is asymptomatic, is psoriasis or dermatitis of palms or soles. Primary skin infections are sometimes considered in more crusted examples.

    Treatment is that of the underlying cause plus treatments as for psoriasis.

White/Cox: Diseases of the Skin, 2ed.(c) 2006, Elsevier Inc. All rights reserved.