SYPHILIS TERTIARIA

Syphilis tubero-serpiginosa.

The tubercular syphilid may appear from one to
forty years after the onset of the disease. Individ-
ual tubercles are pinhead to hazel-nut sized nodules.
Their evolution is like that of an ordinary boil, but
without the signs of inflammation. They are firm,
elastic, rounded, smooth or slightly scaly, brownish
red protuberances. Their most peculiar and typical
characteristic is a tendency to occur in segmental
groups or to coalesce with the formation of circinate
or serpiginous patches or tracts, and the fusion is
usually so intimate that individual tubercles are no
longer to be distinguished. They disappear by ab-
sorption, usually with some exfoliation of the epi-
dermis, or break down with the formation of shallow
or deep ulcers (ulcero-serpiginous syphilid). In
either case there generally results more or less scar-
ring or atrophy of the skin. Not uncommonly new
tubercles continue to arise on the border of an old
group or at the edge of a scar left by the involution
of older tubercles, and thus a patch may grow from

a fraction of an inch to four or five inches in diam-
eter; or a serpiginous ridge or plaque of coalesced
tubercles may advance by peripheral extension.
This development is generally quite slow, and some-
times weeks or months go by without material
change in the appearance of a lesion. There may
be one or several groups of lesions on any part of
the body. If any predilection exists it is for the
face, especially the nose and forehead. The distribu-
tion is asymmetrical. Subjective symptoms are ab-
sent unless ulceration has taken place. when there
may be slight tenderness. **DIAGNOSIS:** Confusion
of the non-ulcerating tubercular syphiloderm with
rosacea, leprosy, ring-worm, or tuberculosis ver-
rucosa cutis might occur as the result of hasty and
superficial examination, but the peculiar features
of the tubercular syphilid, together with the history
and possibly the signs of an earlier eruption, usually
furnish sufficient grounds for a diagnosis without
resort to a microscopic examination or therapeutic
test. **TREATMENT:** Mercury and potassium iodid.

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