Tuberculous Ulcerating Syphilide, showing Lesions in Different Stages.
The syphilodermas have certain peculiarities which are striking and distinctive; they are symmetrically distributed; their color is characteristic, and is due to the disease of the bloodvessel walls, which has been referred to, by which stasis is favored and exudation encouraged. The pigmentation is often striking, and, whatever it may be at first, it assumes a tint described by the terms “raw ham” or “coppery.” Dark pigmentation may take the place of the lighter colored, as the sole evidence of the existence of the previous lesion. Occasionally, however, the normal pigment of the skin disappears and a bleached-out area marks the site of the previous lesion. This is often irregular in shape and considerable in size. Such a spot is spoken of as leukoderma. Again, the syphilodermas are generally polymorphous, and seem to be capable of imitating almost every known non-specific skin affection; so close is the resemblance that it often requires careful study of the case to permit of diagnosis. The absence of itching is also a feature of most of these cases.
The early syphilides are superficial, distributed generally and symmetrically, and disappear spontaneously.
When skin lesions are clustered, as in the macular and papular forms, they usually group themselves symmetrically and in more or less circular outline. When, however, they are too regularly arranged, it may be taken as evidence of their older and more relapsing character.
The later skin lesions of syphilis differ in several respects from the earlier. They are less regularly grouped; they involve a greater depth of tissue; they tend to ulcerate and to leave permanent scars; and they have around them a more infiltrated area, probably because they are deeper. They are, however, not so infectious as the earlier lesions, and it is rare that they are of serious menace to others. (See [Plates VIII], [IX], [X].)
Fordyce and others have pointed out that the prompt and specific influence of mercury and even of iodine upon these eruptions is an instance of the selective action of certain drugs, and nothing could be more conspicuous in demonstrating it.
Certain types of syphilide are common in the earlier stages and others in the later; there may be a well-defined limit between the two, since in not a few instances all types seem to be combined.
The first eruption of so-called secondary syphilis assumes the erythematous or macular type, and has been referred to as roseola syphilitica. It appears as a generalized eruption, in spots varying from 0.5 to 1 Cm. in size, which are of a vivid color and scarcely elevated above the surface. It commences usually upon the abdomen, proceeds to the chest, and then to the extremities. It does not often appear upon the face. Two or three weeks may be consumed in its generalization over the entire body. If let alone it has a duration of a few days to several weeks, and may then fade away, leaving nothing to indicate its presence save a slight pigmentation.
Of more pronounced character is the papular eruption, which commences as a small papule, and is described as lenticulopapular and miliary papular. At first these are generalized, then become circumscribed, and exhibit transition forms from the early to the later type of lesions. The papules vary in size from that of a millet-seed to that of a split pea; even this type may disappear without ulceration or suppuration.