Infentile syphillis -cutaneous affections

-JAHR Georg Heinrich Gottlieb

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In the case of syphilitic children, the skin symptoms show themselves first and foremost. Among them we distinguish:
(1) The pemphigus of new-born infants, which we have described in the second division, and which usually breaks out in the palms of the hands, and on the soles of the feet, and consists of vesicles which, surrounded by a violent-red areola, reveal, after bursting, ulceration of the subjacent integuments.
(2) The various pustules and tubercles, appearing either flattened, salient, tubercular, scurfy, ulcerated, or chancrous, the first-named of which, the so-called flat or mucous tubercles, mostly break out on the scalp, in the face, on the chin, scrotum, at the margin of the anus, on the thighs, hands, and feet; whereas the ulcerous, phagedæmic tubercles sometimes cover both extremities.
(3) Chancres. These are partly protopathic, partly consecutive, and, in their form, deviate but little from the known kinds; for here, too, they either occur as simple or as indurated, elevated, and phagedænic chancres. They occur most frequently at the frænulum of the tongue, on the velum palati, and in the fauces, in the shape of small, round, somewhat prominent vesicles that soon burst; whereas, if they occur on the inner surface of the cheeks, they appear in the shape of small cracks, and on the hands and feet in the shape of true rhagades; those that break out on the scalp and in the face are phagedænic, and soon terminate in fatal gangrene.

Infantile syphillis

(4) Ulcers on the heels. This is a peculiar affection on syphilitic children, commencing with redness and inflammation of the skin of the heel. This redness increases, the skin ulcerates, and whole patches of the cellular tissue under the coverings of the heel-bone become detached, so that the cushion forming the heel finally drops off entirely.
(5) Thickening of the skin of the palms of the hands and soles of the feet. This is a species of psoriasis; the skin becomes rough, thick, shrivelled, like that of washerwomen; the affected parts swell up, assume a red or pale yellow color, the skin hardens, and shows more or less deep, sometimes ulcerated rhagades; at a later period scales form, which fall off, and then form anew, until this process stops entirely, and the whole of the indurated epidermis becomes detached. After this is accomplished, the affection assumes a different form; the old epidermis is replaced by a new one of the thickness of a thin pellicle; feet and hands assume a dark-blue hue, especially around the finger and toe-nails; the nails soften, and trifling ulcerations sometimes break out all around. Next to the above-mentioned peculiar color of the skin, the dry coryza and the rhagades of the lips, this induration of the skin, according to Trousseau and Laregue, constitutes one of the most frequent phenomena of infantile syphilis.
(6) Rhagades on the lips and at the anus. These cracks show themselves where the mucous membrane unites with the outer skin. They are located in the folds of the membrane, and are so much deeper and broader the further remote they are from the epidermis; their bright-red and bleeding bottom, and their brown hue, imparts to the lips a very peculiar appearance. If no pustules have as yet formed in the corners of the mouth, they usually break out in the mesian line of the lips, generally in company with these pustules, and simultaneously with the dusky-black color of the skin; and often become the direct cause of a transmission of the syphilitic disease to the nipples of the nurse.
(7) Syphilitic roseola This exanthem resembles measles, but is much darker and exceedingly fugitive; remains only four or five days, but is always the precursor of much more troublesome phenomena, since the copper spots, after becoming more marked, do not delay changing to pustules and afterwards to ulcers.
(8) Fig-warts. These break out very seldom on infants, and, if at all, generally are found located on the mucous membranes. They are likewise seen around the anus, on the outer surface of the labia majora, or between the sexual organs and the thighs.
(9) Erysipelatous exanthems The skin is wrinkled, covered with brown-yellow pimples, and erysipelatous spots; here and there the epidermis becomes raised, or it may even become raised over the whole body and suffer destruction at the same time the face and whole body show the emaciated appearance of old age, which is so exceedingly characteristic of the syphilitic affections of children.