Late Syphilids of the Nodular and Nodulo-Ulceratiye Type

Abstract

The cutaneous manifestations of late syphilis may be divided into (1) solitary gumma and (2) nodular syphilid. The nodular syphilid may or may not become ulcerated; consequently, it is designated a nodular ulcerative or a nonulcerative syphilid. Late syphilids of the palms and soles may be erythematous and scaly and simulate the commoner squamous dermatoses such as psoriasis and epidermophytosis, and therefore will not fit well into this classification of late syphilids. Such a late palmar and plantar syphilid may not show many of the characteristics so consistently observed in late nodular syphilids located elsewhere. However, nodular syphilids may occur on the palm or sole and the squamous syphilids of these areas usually have one or more of the characteristics of late syphilids such as well defined, arciform, indurated margins or grouped indurated papules.

Because syphilis is a disease of protean manifestations, its late systemic effects often are unrecognized. However, the physical characteristics of late nodular syphilids are so distinctive that when certain combinations of these features are present in a lesion they are considered pathognomonic. This enables a physician who is familiar with the morphology of late syphilids to detect the presence of the disease in certain patients without the aid of serologic reactions. The blood serologic reactions of patients with late syphilis frequently are negative, and also individuals with late cutaneous syphilis often do not show other evidence of syphilis such as clinical signs of cardiovascular or neurosyphilis. Therefore, the clinical recognition of a late syphilid may be. . .