The small acuminated-pustular syphiloderm, the large acuminated-pustular syphiloderm, the small flat-pustular syphiloderm, and the large flat-pustular syphiloderm. #Describe the small acuminated-pustular eruption of syphilis.# The _small acuminated-pustular syphiloderm_ (_miliary pustular syphiloderm_) is an early or late secondary eruption, commonly encountered in the first six or eight months of the disease. It consists of a more or less generalized, disseminated or grouped, millet-seed-sized, acuminated pustules, usually seated upon dull-red, papular elevations. The eruption is, as a rule, profuse, and usually involves the hair-follicles. The pustules dry to crusts, which fall off and are often followed by a slight, fringe-like exfoliation around the base, constituting a grayish ring or collar. Minute pin-point atrophic depressions or stains are left, which gradually become less distinct. Scattered large pustules, and sometimes papules, are not infrequently present. #Describe the large acuminated-pustular eruption of syphilis.# The _large acuminated-pustular syphiloderm_ (_acne-form syphiloderm_, _variola-form syphiloderm_) is a more or less generalized eruption, occurring usually in the first six or eight months of the disease. It consists of small or large pea-sized, disseminated or grouped, acuminated or rounded pustules, resembling the lesions of acne and variola. They develop slowly or rapidly, and at first may appear more or less papular. They dry to somewhat thick crusts, and are seated upon superficially ulcerated bases. It pursues, as a rule, a comparatively rapid and benign course. In relapses the eruption is usually more or less localized. #How would you distinguish the large acuminated-pustular syphiloderm from acne and variola?# In acne the usual limitation of the lesions to the face or face and shoulders, the origin, more rapid formation and evolution of the individual lesions, and the chronic character of the disease, are usually distinctive points. In variola, the intensity of the general symptoms, the shot-like beginning of the lesions, their course, the umbilication, and the definite duration, are to be considered. The presence or absence of other symptoms of syphilis has, in obscure cases, an important diagnostic bearing. #Describe the small flat-pustular eruption of syphilis.#