# Skin Diseases of Children/Syphilis Haereditaria

Plate XII
Syphilis Hereditaria.
From the collection of Photographs of
Dr. George Henry Fox.
VARIOUS SKIN DISEASES OF CHILDREN.
Syphilis hereditaria.—When syphilis is transmitted from one generation to another it may result in the death of the foetus in utero, or in the development of an infantile eruption which either is present at birth or appears shortly after. In most cases it manifests itself within three months, and always during the first year. The eruption may be erythematous and appear as a general roseola, similar to the earliest eruption of acquired syphilis, or in the form of dull-red patches on the trunk and upon the palms and soles, which present a dry, scaly appearance quite characteristic of the inherited disease. About the mouth the skin is often dry and fissured, and on the buttocks the patches are apt to become raw and even ulcerated at various points. In some cases the eruption assumes a papular character (see plate), and numerous yellowish-red and slightly scaly discs are seen upon the buttocks, thighs, and face, and occasionally over the greater portion of the body. In rare instances the papules are small, flattened, and shining, and present a strong resemblance to lichen planus. Pustular lesions of an ecthymatous character are sometimes present, especially in infants who are ill-nourished and poorly cared for. Bullous lesions are not infrequently seen upon the palms and soles and other portions of the body, and in fact are much more common than in the acquired disease of adult life.
In connection with these early cutaneous manifestations a notable condition of malnutrition is usually observed, and certain characteristic symptoms resulting from affection of the mucous membranes and the osseous structures. The nasal passages are often inflamed and obstructed by an accumulation of mucus. The larynx may be affected, giving rise to a peculiar hoarse cry.
The prevention of hereditary syphilis is more important than ​its treatment, and the physician is often in a position to advise against the premature marriage of syphilitic patients, and thus prevent an amount of misery and suffering which he could never cure.
In the treatment of infantile syphilis a half-grain or more of mercury with chalk may be administered three times a day, and a speedy improvement expected if the child is properly cared for. When irritability of the stomach and intestines is present it is advisable to adopt the plan of mercurial inunctions. A mass of mercurial ointment, the size of a small marble, should be spread upon a piece of flannel and bound around the trunk or thighs, its position changed from day to day to prevent excessive irritation of the skin.
In treating mucous tubercles and superficial ulceration upon the buttocks and about the genitals, calomel powder mixed with three to five parts of starch may be sprinkled over the raw surface, care being taken to keep the affected parts dry and clean. The importance of fresh air and nutritious food must never be forgotten, and when the symptoms of the disease have abated the syrup of iodide of iron, and perhaps cod-liver oil, may usually be given with great benefit.
Erythema nodosum is one of the forms of erythema multiforme, though commonly described in dermatological text books as a distinct disease. It occurs most frequently in childhood, and the female sex seems especially prone to suffer from it.
The lesions in this affection are red, painful swellings, looking very much like recent contusions, and are most frequently seen over the tibiae. They are usually associated with slight fever, considerable malaise, and in some cases with articular pains. Both legs are commonly affected, and rarely are the lesions found elsewhere. In some cases, however, the lesions are numerous and found upon the thighs as well as the legs (Fig. 54), and in rare instances the forearms may be affected. The lesions are at first of a bright-red hue, but soon become dull red or purplish, and usually disappear in a week or two. New lesions sometimes continue to appear and prolong the duration of the disease. The individual nodules usually last from eight to fourteen days. New nodules appear, as a rule, during the first two weeks, and the disease may therefore last from three to six weeks. In exceptional cases it may continue for months.
The cause of erythema nodosum is obscure. Most patients appear to be in poor condition, and a rheumatic tendency is