ed, macules. When well
established they do not entirely disappear under pressure. At first a
pale-pink or dull, violaceous red, they later become yellowish or
coppery. The eruption is generally profuse; the face, backs of the hands
and feet may escape. It persists several weeks or one or two months; as
a rule, it is rapidly responsive to treatment.

#How would you distinguish the macular syphiloderm from measles, roetheln
and tinea versicolor?#

Measles is to be differentiated by its catarrhal symptoms, fever, form
and situation of the eruption; roetheln, by its small, roundish,
confluent pinkish or reddish patches, its precursory pyrexic symptoms,
its epidemic nature, and short duration; tinea versicolor by its
scaliness, peripheral growth, distribution and history.

And, finally, by the absence or presence of other symptoms of syphilis.

[Illustration: Fig. 51. Macular Syphiloderm.]

#What several varieties of the papular eruption of syphilis are met with?#

There are two forms of the papular eruption--the small and large; those
of the latter type may undergo various modifications.

#Describe the small-papular eruption of syphilis.#

The _small-papular syphiloderm_ (_miliary papular syphiloderm_) usually
shows itself in the third or fourth month of the disease, and consists
of a more or less generalized eruption of disseminated or grouped, firm,
rounded or acuminated pin-head to millet-seed-sized papules, with smooth
or slightly scaly summits, and in some lesions showing pointed
pustulation. Scattered minute pustules and some large papules are
usually present. The eruption is profuse, most abundant upon the trunk
and limbs; and in the early part of the outbreak is of a bright- or
dull-red color, later assuming a violaceous or brownish tint. It runs a
chronic course, is somewhat rebellious to treatment, and displays a
tendency to relapse.

[Illustration: Fig. 52. Moist Papules. (_After Miller._)]

#How would you distinguish the small-papular syphiloderm from keratosis
pilaris, psoriasis punctata, papular eczema, and lichen ruber?#

The distribution and extent of the eruption, the color, the grouping,
with usually the presence of pustules and large papules and other
concomitant symptoms of syphilis, are points of difference. Pustules
never occur in the several diseases named, except in eczema.

#Describe the large-papular eruption of syphilis.#

The _large-papular syphiloderm_ (or _lenticular syp