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It consisted of closely disposed papules of the size of a pin-head, and several days after the disappearance of the eruption a fine, bran-like desquamation of the epidermis ensued. Brand has also seen an eruption on the trunk and flexor surfaces, accompanied with fever, from the ingestion of opium.
They are papules occurring on those parts of the body where the skin is habitually moist, and especially where two skin surfaces are in contact.
The front of the chest below the nipples was covered with dark papules the size of a pin's head. The back, the buttocks, the face, and the scalp presented similar lesions. The most striking lesions were three ulcers one on the back of the right hand, one on the right temple, and the other on the left cheek.
Or, again, a little pharyngeal irritation which would ordinarily be incapable of disturbing sleep may be sufficient to keep the child wide awake all night with persistent and violent coughing. The little irritating papules of nettlerash from which many children suffer are commonly disregarded by busy, happy children during the day, and even at night hardly suffice to cause disturbance.
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.
It was usually confined to the hands and feet, but when worst affected the whole body. It was absent as long as he preserved the horizontal posture, but came on directly when he rose; it was always increased in the summer months. At the height of the attack the man lost appetite and spirit, had a pricking sensation, and sometimes minute red papules appeared all over the hand.
The tongue often presents a combination of lesions, including ulcers, patches where the papillæ are absent, fissures, and raised white papules resembling warts, especially towards the centre of the dorsum. These lesions are specially apt to occur in those who smoke, drink undiluted alcohol or spirits, or eat hot condiments to excess, or who have irregular, sharp-cornered teeth.
Soon afterward the same appearances occurred on both shoulders, and, in the same order, spread gradually down the outer sides of the arms first black specks, then papules, and lastly pigmentation. The black specks soon began to project, and comedo-like plugs and small, spine-like growths were produced. Both the spines and plugs were very hard and firmly-rooted.
Among the diagnostic features of the skin affections the following may be mentioned: They are frequently, and sometimes to a marked degree, symmetrical; more than one type of eruption papules and pustules, for example are present at the same time; there is little itching; they are at first a dull-red colour, but later present a brown pigmentation which has been likened to the colour of raw ham; they exhibit a predilection for those parts of the forehead and neck which are close to the roots of the hair; they tend to pass off spontaneously; and they disappear rapidly under treatment.
They vary in size and distribution, being sometimes small, hard, polished, and closely aggregated like lichen, sometimes as large as a shilling-piece, with an accumulation of scales on the surface like that seen in psoriasis. The co-existence of scaly papules and faded roseoles is very suggestive of syphilis. Other types of eruption are less common, and are met with from the third month onwards.
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