Syphilis

Syphilis is a disease that involves, not only the skin, but every other organ and tissue of the body. Its cutaneous relations, however, are those which chiefly concern us.

The first visible lesion of syphilis usually appears in from ten to twenty days after an infective intercourse, as a small papule or erosion, going on to ulceration, and most frequently situated on the genital organs. Extragenital chan­cre, however, may be met with in a variety of locations, more frequently, perhaps, about the mouth than elsewhere. This lesion is termed a chancre. In a short time a limited induration of the subjacent tissue occurs, so that the chan­cre when taken between the fingers appears to have a hardened base. This induration may be, and frequently is, absent in genital chancres in women, and the lesion may be altogether overlooked. In the course of two or three weeks after the appearance of the chancre certain of the lymphatic glands become involved, and take on enlargement and hardness. The glands chiefly noticeable in this respect are the inguinal, cubital, post-cervical, and post-auricular.

About this time, or a little later, we may expect a generalized outbreak upon the skin.

The various manifestations of syphilis on the skin, or syphilides, as they are commonly called, present different types and degrees of severity, and involve the skin either superficially or deeply. We may, however, classify them to a certain extent, and in doing so will find that they partake of one or the other of the following characters, namely: mucular, papular, tubercular, pustular, squamous, billions, and gummatous, together with ulceration, occurring with, or following, any of the five types last mentioned.

The appearance of the first cutaneous eruption ushers in what is termed the secondary period of the disease.


As a rule, the first eruption is macular, and consists of small, rosy points or spots usually called syphilitic roseola. These present little or no elevation, and disappear under pressure, showing that they are little more than points of congestion. They usually pass away within a few weeks, with or without treatment. They are chiefly met with on the trunk and extremities.

Another and much rarer macular lesion is the pigmentary syphilide, which appears as dark-colored spots on the neck, and almost wholly confined to young females. After a time a portion of the pigmentary deposit fades away, producing a somewhat characteristic appearance somewhat resembling vitiligo.

After the macules of syphilis have disappeared, or even before they are quite gone, a generalized eruption of papules may appear. These are solid elevations, and not unfrequently present minute scales at their apices. Should the patient be broken in health, a tendency to pustulation and ulceration may be developed; and we may have the papules becoming purulent at their summits, or we may have a frankly pustular eruption from the outset. As the disease progresses there is a tendency to deeper involvement of the integument and larger size of the lesions, so the papules are not uncommonly followed by tubercles, not perhaps as numerous as the papules, but still freely distributed over the entire surface. These not infrequently undergo ulceration and become covered with greenish-black crust.


In addition to the foregoing, we may have the appearance of reddish and not greatly elevated patches, covered with white scabs, constituting the so-called squamous syphilide. These various manifestations may occupy a year or more in their evolution, and embrace the secondary period of the disease. After the disappearance of these various eruptions, there is not infrequently a decided halt in the progress of the disease, and the patient may go on for a considerable period, for years even, without a fresh outbreak. When it does come, however, it ushers in what is known as the tertiary stage of the disease. In the tertiary period of syphilis the eruptions are usually of a tubercular or ulcerative character, and, instead of being generally and somewhat evenly distributed over the surface, they are usually collected into groups; for instance, half a dozen or more tubercles may form a group or patch, and there may be one or several such patches. As a rule, the number of patches is limited. The individual lesions sometimes disappear by absorption, but very frequently undergo ulceration, and in either case leave indelible scars. In this stage of syphilis we meet with the lesion known as the gumma. It consists of a small tumor, which usually undergoes softening throughout its entire substance, and terminates by ulceration. This lesion is not confined to the skin, but may involve almost any organ of the body.