The _bullous syphiloderm_, (of acquired syphilis) is a rare and usually late eruption, appearing in the form of discrete, disseminated, rounded or ovalish, pea- to walnut-sized, partially or fully distended, blebs. The serous contents soon become cloudy and puriform. In some cases the lesions are distinctly pustular from the beginning. The crust, which soon forms, is of a yellowish-brown or dark green color, and may be thick and stratified (_rupia_), as in the deep variety of the large flat-pustular syphiloderm. The erosions or ulcers beneath the crusts secrete a greenish-yellow fluid. It is a malignant type of eruption, and is usually seen in broken-down subjects. It is not an uncommon manifestation of hereditary syphilis (_q. v._) in the newborn. [Illustration: Fig. 57. Tubercular Syphiloderm.] #How is the bullous syphiloderm to be differentiated from other pemphigoid eruptions?# By the gravity of the disease, the accompanying ulceration, the course and history; and by other evidences, past or present, of syphilis. #Describe the tubercular eruption of syphilis.# The _tubercular syphiloderm_ (_syphiloderma tuberculosum_) may exceptionally occur within the first year as a more or less generalized eruption. As a rule, however, it is a late manifestation, at times appearing many years after the initial lesion; is limited in extent, and shows a decided tendency to occur in groups, often forming segments of circles and circular areas, clearing in the centre and spreading peripherally. It consists (as a late, limited manifestation) of several or more firm, circumscribed, deeply-seated, smooth, glistening or slightly scaly elevations; rounded or acuminated in shape, of a yellowish-red, brownish-red or coppery color and usually of the size of small or large peas. Several groups may coalesce, and a serpiginous tract result (_serpiginous tubercular syphiloderm_). The lesions develop slowly, and are sluggish in their course, remaining, at times, for weeks or months, with but little change. As a rule, however, they terminate sooner or later, either by absorption, leaving a more or less permanent pigment stain with or without slight atrophy (_non-ulcerating tubercular syphiloderm_), or by ulceration (_ulcerating tubercular syphiloderm_). [Illustration: Fig. 58. Ulcerating Tubercular Syphiloderm.] #Describe the ulcerating tubercular syphiloderm.# The ulceration may be superficial or deep in character, and involve several or all of the lesions forming the group. The patch may consist, therefore, of small, discrete, punched-out ulcers, or of one or more continuous ulcers, segmented, crescentic or serpiginous in shape. They are covered with a gummy, grayish-yellow deposit or they may be crusted. As the ulcerative changes take place, new lesions, especially about the periphery of the group or patch, may appear from time to time. [Illustration: Tubercular Syphiloderm.] [Illustration: Large-pustular Syphiloderm.]