Secondary stage manifestations generally are nonscarring and irreversible. Patients may develop relapses at intervals up to 5 years after infection. Relapsing lesions tend to occur in the perioral, perianal, and periaxillary areas. The disease then enters a noninfectious latent period, and patients do not exhibit any signs or symptoms. Progressively enlarging, painless, subcutaneous nodules develop, which undergo abscess formation, necrosis, and ulceration.
Lesions have well-defined edges and an indurated base with granulation tissue and yellowish slough.
Ulcers may become infected, causing destruction of underlying structures. They also may coalesce, forming serpiginous tracts that heal with keloid formation, which leads to crippling deformities and contractures. Hyperkeratosis and keratoderma of the palms and soles as well as juxtaarticular ulcerated gummatous nodules may accompany lesions. Late skeletal lesions consist of hypertrophic periostitis, gummatous periostitis, osteitis, and osteomyelitis. Chronic osteitis of the tibia can lead to saber shins.