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Updated: May 16, 2025
N.B. The case alluded to, in the last of the above replies, was, in the first instance, papular eruption; the base of each papula being surrounded by an inflamed ring; the eruption was thickest on the thorax, and on the arms; in its progress, the eruption became pustular, the pustules being in circumference about half the usual size of the vaccine vesicle; on the twelfth day, the crusts had dropped from some of the smaller pustules; and, by the seventeenth day, they had all dropped off, leaving a mark, but not in any manner pitted; and which, I think, promises to be permanent.
These usually consist of relapses of certain of the affections of the skin, mouth, or throat, already described. In the skin, they may assume the form of peeling patches in the palms, or may appear as spreading and confluent circles of a scaly papular eruption, which if neglected may lead to the formation of fissures and superficial ulcers.
Chevalier mentions that through contact of the drug workmen in the manufacture of quinin are liable to an affection of the skin which manifests itself in a vesicular, papular, or pustular eruption on different parts of the body.
A pustular eruption, not unlike that of acne, is sometimes a prominent feature, but is not characteristic of syphilis unless it affects the scalp and forehead and is associated with the remains of the papular eruption.
Although all types of skin affection are met with in the inherited disease, the most important is a papular eruption, the papules being of large size, with a smooth shining top and of a reddish-brown colour. It affects chiefly the buttocks and thighs, the genitals, and other parts which are constantly moist.
On a mucous surface the papular eruption assumes the form of mucous patches, which are areas with a congested base covered with a thin white film of sodden epithelium like wet tissue-paper. They are best seen on the inner aspect of the cheeks, the soft palate, uvula, pillars of the fauces, and tonsils.
Marsden reports a case in which, following secondary papular syphilis and profuse spontaneous ptyalism, there was vicarious secretion of the urinary constituents from the skin. Instances of the anomalous exit of urine caused by congenital malformation or fistulous connections are mentioned in another chapter.
It is usually followed by a papular eruption, the individual papules being raised above the surface of the skin, smooth or scaly, and as they are due to infiltration of the skin they are more persistent than the roseoles.
After becoming papular and increasing to the size of a pea, desquamation takes place, leaving a dull-red surface, over which in the course of several weeks there develops a series of small yellowish-white spots, from which serum exudes, and, drying, forms a thick scab.
From an experience in the treatment of thirty cases of different kinds viz., obstinate circumscribed moist patches on the hands and arms, intensely itching papular eczema of the flexures and face, infantile moist eczemas, etc. he recommends the following procedure.
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