This is a young male, with erythematous scaly rash on the hands, feet and abdomen without obvious discomfort and other self-conscious symptoms, had mistaken for eczema, anti-allergy treatment was not effective, this patient appeared before me, professional experience told me to check syphilis two, the final test results confirmed the diagnosis of stage 2 syphilis Syphilis is endemic worldwide, according to WHO estimates, there are about 12 million new cases each year worldwide, mainly in South Asia, Southeast Asia and sub-Saharan Africa. Syphilis has been growing rapidly in China in recent years and has become the STD with a high number of reported cases. Latent syphilis accounts for the majority of reported syphilis, and stage 1 and 2 syphilis are also common. The skin and mucous membranes of syphilis patients contain syphilis spirochetes, and people who do not have the disease can get the disease if there is a slight break in the skin or mucous membranes during sexual contact with syphilis patients. Rarely, the disease can be transmitted through blood transfusions or routes. Acquired syphilis (acquired) early syphilis patients are the source of infection, more than 95% is transmitted through risky or unprotected sex, a few through kissing, blood transfusions, contaminated clothing, etc. Fetal syphilis is transmitted by pregnant women with syphilis, and the chances of transmission to the fetus are quite high if the pregnant women with first or second stage and early latent syphilis. The case above is a stage II syphilis, which is characterized by a stage II syphilis rash, and generally occurs after a period of asymptomatic reoccurrence after the genital rupture has subsided. The syphilis spirochete spreads with the bloodstream and causes multi-site damage and multiple lesions. It invades the skin, mucous membranes, bones, internal organs, cardiovascular and nervous systems. When syphilis enters the second stage, the syphilis serological test is almost 100% positive. A syphilis rash appears and is characterized by recurrent occurrence. Stage II cutaneous syphilis rash occurs in 80-95% of patients. It is characterized by a variety of rash patterns and recurrence, widespread and symmetrical, painless and non-itchy, mostly without scarring after healing, and rapidly resolves with anthelmintic treatment. The main rash types are maculopapular, papular, pustular syphilis rash and flat warts, palmoplantar syphilis rash, etc. The second stage syphilis rash has a polymorphic nature, dermatologists called “universal imitators”, when the dermatologists found some painless suspected syphilis rash will be vigilant, follow up the medical history and blood test syphilis two for screening. The rash that is not painful or itchy should not be treated on its own, but should be seen by a doctor in time for proper diagnosis and standardized treatment under the guidance of a professional dermatologist.