A manual of syphilis and the venereal diseases, . atment and hygienic aidwhich he receives. When the ulcer spreads beyond themass of the elementary tubercle, it passes into the cate-gory of gummatous lesions; but if the degenerationis limited to the original tubercle, the clinical picture isdistinct. In these cases circlets, complete or partial, ofcrusted tubercles or of crust-covered and circumscribed 114 SYPHILIS AND THE VENEREAL DISEASES. ulcers surround an unaffected or infiltrated area of skin,the color of which is of the type seen in the resolutivegroups described above. Upon the face, w
A manual of syphilis and the venereal diseases, . atment and hygienic aidwhich he receives. When the ulcer spreads beyond themass of the elementary tubercle, it passes into the cate-gory of gummatous lesions; but if the degenerationis limited to the original tubercle, the clinical picture isdistinct. In these cases circlets, complete or partial, ofcrusted tubercles or of crust-covered and circumscribed 114 SYPHILIS AND THE VENEREAL DISEASES. ulcers surround an unaffected or infiltrated area of skin,the color of which is of the type seen in the resolutivegroups described above. Upon the face, where theselesions are of special importance and of frequent occur-rence because of the exposure of this region of thebody to frictional, accidental, and atmospheric influences,the arrangement may be less distinctively in circles;as, for example, over the sides of the nose, where crustednodules may be indiscriminately sprinkled over one orboth sides with as little order as the lesions of acnewith which this syphiloderm has at times been Fig. 5.—Serpiginous tubercular syphiloderm (after Stelwagon). Upon the trunk and the limbs, however, the tuberclesare often not merely grouped originally in circles orparts of circles, but they spread at times by serpiginousextension until wide areas have been swept over (), leaving, where the activity of the process was oncedeclared, broad, palm-sized and even much larger cicatri-cial patches where the skin is thinned, and where one canrecognize the pea-sized and smaller, depressed and cir-cumscribed points, each representing the site of a formertubercle and ulcer. Often giant circles of involvement, SYPHILIS OF THE SKIN. 11 5 affecting, for example, an entire buttock or a portion ofthe back, have in this way indolently progressed foryears, the nature of the disorder being misunderstoodfor that period. Many patients thus afflicted have beentreated for years for lupus, tuberculosis, and otheraffections, relief having speedily be
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