The skin lesions in hereditary syphilis are very characteristic.
Certain forms of these appear only in the congenital, never in the acquired disease. These are syphilitic pemphigus and a diffuse infiltration of the skin.
One must distinguish in early hereditary syphilis of infants between diffuse circumscribed ski n lesions. While the latter, on the whole, correspond to certain changes in the skin found in acquired syphilis, the former give to the child a characteristic appearance which manifests itself primarily in the con sistency of the skin of the face. I have called this change diffuse, superficial, syphilide, or diffuse hered itary-syphilitic skin in filt ra tion. Soon after the appearance of the nasal symptoms the skin of the face assumes a peculiar, pale, yellow' tint, and is somewhat glossy, symptoms that depend not so much upon insufficient blood supply, as upon a mild infiltration of the papillary portion of time skin and upon increased tension in the rete of Malpighi.
The color resembles at first a pale cafe au lait, after a longer period of time when more pigmentation has taken place, the color of the finger of a cigarette smoker. These changes are especially marked on the cheeks and on the chin, but also appear like- spectacle rims on the orbital borders, or like the expanded wings of a butterfly about. the root of the nose, or like a gotee on the under lip.
A diffuse infiltration of the borders of the lips is very character istic. This produces a peculiar stiffness, a brownish red color, and a striking glossiness (Fig. 117). Soon radial fissures and rhagades appear in the infiltrated skin areas in those places where muscular action keeps the skin in motion, as about the mouth and nostrils, and on the eyelids. Similar infiltrations affect the hairy scalp leading to loss of hair, and also with great partiality, the skin of the flexor surfaces of the lower half of the body and that of the genito-anal region.
External irritants exert an undeniable influence upon the production of this form of syphilis. This accounts for the predilection for the lower
half of the body, which is constantly exposed to the irritating effect of feces and urine. Not rarely one sees in congenitally syphilitic infants. during the eruptive stage the conversion of an intertriginous skin affec tion into a diffuse superficial syphilide, with a change from a light red, oozing skin to one that is brownish and has a peculiar stiffness, dryness, and glossiness. Frequently the skin infiltration is localized on the flexor surfaces of the lower extremities like the leather portion of a pair of riding breeches.
Independently of external macerating influences, the skin of the soles of the feet and of the palms of the hands is always involved at the very first in a diffuse manner, on account of the early and very abundant development of sweat glands in those regions. The skin becomes hard, smooth, and free from wrinkles and glossy as if varnished or painted with water glass, with a color that at first is reddish yellow later brownish, or salmon colored. Very frequently diffuse involvement of the skin of the soles, palms and face, is a forerunner of the appearance of regular, circumscribed exantliemata, frequently, however, it forms the only cutaneous lesion.
Diffuse hereditary-syphilitic skin infiltration may be divided into three forms. or stages, between which transitional forms exist.
1. Diffuse smooth infiltration, or erythematosa simplex. This is frequent on the soles and palms, but also on the chin, on the glabella, on the preauricular hairy portions and about the neck. The color of the smooth scaleless skin that is involved may show all kinds of tints front a light cherry red to the darkest blue red.
2. Diffuse, desquamative, or lamellar infiltration. In this the horny layers of the skin are loosened and separated in large lamellar,. or masses, while the texture of the skin appears selerosed and very much thickened.
3. Eroded infiltration. This term applies to all ulcerated, oozing,. moist, and impetiginous forms.