uption of syphilis.#

The _large acuminated-pustular syphiloderm_ (_acne-form syphiloderm_,
_variola-form syphiloderm_) is a more or less generalized eruption,
occurring usually in the first six or eight months of the disease. It
consists of small or large pea-sized, disseminated or grouped,
acuminated or rounded pustules, resembling the lesions of acne and
variola. They develop slowly or rapidly, and at first may appear more or
less papular. They dry to somewhat thick crusts, and are seated upon
superficially ulcerated bases.

It pursues, as a rule, a comparatively rapid and benign course. In
relapses the eruption is usually more or less localized.

#How would you distinguish the large acuminated-pustular syphiloderm from
acne and variola?#

In acne the usual limitation of the lesions to the face or face and
shoulders, the origin, more rapid formation and evolution of the
individual lesions, and the chronic character of the disease, are
usually distinctive points.

In variola, the intensity of the general symptoms, the shot-like
beginning of the lesions, their course, the umbilication, and the
definite duration, are to be considered.

The presence or absence of other symptoms of syphilis has, in obscure
cases, an important diagnostic bearing.

#Describe the small flat-pustular eruption of syphilis.#

The _small flat-pustular syphiloderm_ (_impetigo-form syphiloderm_)
consists of a more or less generalized, pea-sized, flat or raised,
discrete, irregularly-grouped, or in places confluent, pustules,
appearing usually in the first year of the disease. The pustules dry
rapidly to yellow, greenish-yellow, or brownish, more or less adherent,
thick, uneven, somewhat granular crusts, beneath which there may be
superficial or deep ulceration; where the lesions are confluent a
continuous sheet of crusting forms. The eruption is often scanty. It is
most frequently observed about the nose, mouth, hairy parts of the face
and scalp, and about the genitalia, frequently in association with
papules on other parts.

#Are you likely to mistake the small flat-pustular syphiloderm for any
other eruption?#

Scarcely; but when upon the scalp, it may bear rough resemblance to
pustular eczema, but the erosion or ulceration will serve to
differentiate. Moreover, concomitant symptoms of syphilis are to be
looked for.

#Describe the large flat-pustular eruption of syphilis.#

The _large flat-pustular syphiloderm_ (_ecthyma-