Moist Papule (Synonyms: Mucous patch; Mucous papule; Fr.,
Plaques muqueuses; Ger., Schleimhautpapeln).—The usual sites on the
general integumental surface for moist papules are on contiguous or
opposing surfaces, where there is a good deal of natural heat and moisture,
and possibly friction. They are usually met with during the active
or secondary stage of syphilis, as a part of a general eruption or inde­
pendently. The most common situation is around the anus, and about
the genitalia, especially in women; the corners of the mouth, the

nasolabial folds, the axillae, and um­
bilicus are also not unusual situa­
tions. They are also occasionally
met with between the fingers and
toes, just at the web, and beneath
the mammary glands in women.
They commonly begin as ordinary
papules, which flatten down some­
what, become macerated, generally
slightly soft or even spongy, and are
grayish or brownish gray in appear­
ance. Their surface is covered with
a mucoid secretion, which, when
drying slightly, may resemble some-
Fig. 188— Moist papules (after Miller). what a thin, diphtheroid membrane.

Ordinarily, however, the surface
is kept moist and macerated. At first they are commonly fairly well
defined, but later, often from flattening down, especially peripherally,
become much less so. On the other hand, instead of flattening down
they may become hypertrophied, distinctly elevated, the surface some­
what irregular or uneven, and constitute the lesion or form known as
the broad or flat condyloma. Contiguous plaques may coalesce and cover
considerable surface, encircling the anus or also, in the female, involving
and surrounding the vulva. The irregular and uneven surface may
sometimes become clearly warty or papillomatous, the papular base
sharing in the hypertrophy, and the vegetations prominent and closely
packed, giving rise to the manifestation known as the hypertrophic
papillomatous or vegetating papule, sometimes designated the vegetating
syphiloderm, syphilis cutanea vegetans, syphiloderma frambœsioides.
This latter development is also sometimes observed in the various ulcera-
tive syphilodermata. There is usually considerable mucoid or muco-
purulent secretion, which, together with the macerated epithelium, soon,

SYPHILIS

793

unless extreme cleanliness is practised, gives rise to an exceedingly foul,
offensive odor. If neglected, the irritating discharge may produce still
further maceration, and ulceration, more especially between the papil­
lary growths, results. Such cauliflower-like formations are also occa­
sionally met with elsewhere on the surface, where the papules, or some­
times other syphilitic lesions, have undergone irritation, or from neglect—
as, for instance, the scalp.

The moist papule is one of the common symptoms of the active stage
of syphilis, especially about the anus in males, and the anus and vulva
in females, and are often present when the syphilitic eruptive manifesta­
tions are scant on other parts. For this reason it is of value in diagnosis.
As the heat, moisture, and friction of the parts necessarily continue, some
tenderness or soreness often results, and patients usually believe they
have an attack of hemorrhoids. As a rule, moist papules, if thorough
cleanliness is practised, show a tendency to disappear, and are generally
rapidly responsive to treatment. Inasmuch as their characters are well
defined, the diagnosis is not attended with difficulty. They should not
be confused with verruca acuminata (q. v.).

The lesion which occurs on the mucous membrane, especially of the
lips and mouth, usually known as the mucous patch, is a somewhat
similar formation, and may often be looked upon as a flattened, abraded
papule on a mucous surface. They are also seen on the labia minora
surfaces of the vulva and on the mucous membrane of the anus. About
the mouth, their usual situation, they are most commonly found just
within the vermilion border, often extending on to the latter, and espe­
cially at the corners of the mouth and the lower lip. The inner surface
of the cheeks is a favorite location, especially opposite or near the last
molar. The tongue, uvula, tonsils, velum palati and its pillars, and the
gums are also frequently its site. There may be one, several, or more—
generally two or three. They are usually observed during the active or
second stage of the disease, especially the early period of it, although
they are also seen later. They are sometimes called “opaline patches,”
owing to the appearance presented; they have a grayish-white color,
such as is produced by penciling with silver nitrate, often with a pinkish-
red periphery. This term opaline is probably more properly applicable
to the very slight opalescent, insignificant patches which occur occa­
sionally on the tongue, and sometimes so numerously as to give it a map-
like appearance. As a rule, mucous patches are but slightly elevated,
always flattened, and not infrequently slightly depressed; are rounded,
ovalish, or irregular in outline, and of various sizes. Sometimes, instead
of grayish or grayish-white color, they are a pale rosy or rosy­ white;
and not infrequently, when closely examined, show a thin, film-like
membranous coating, which may be an intimate and closely agglutinated
part of the patch or somewhat loosened. If detached, the underlying
surface is noted to be reddish, appearing as a superficial abrasion or ero­
sion, often distinctly raw looking. It is not uncommon in some cases
to see several plaques, their appearances varying as just described.
They are sometimes quite painful, especially when taking hot drinks and
hot foods and acid fruits. The patches, more particularly the abraded

794

NEW GROWTHS

plaques, have a slight or moderate mucoid discharge, commonly collecting
as a thin coating, and which is extremely contagious.

In some instances the abraded or eroded surface of a plaque becomes
more deeply invaded, and a rounded or irregular superficial ulceration
results, with a mucoid or mucopurulent discharge; occasionally the
ulcerative action extends deeply and causes considerable destruction.
Later in the disease the grayish-white plaques sometimes undergo thick­
ening, become more or less opaque, and doubtless constitute some cases
of leukoplakia buccalis (q. v.).

In the early stage of active syphilis it is not uncommon to find a
patchy or confluent redness of the posterior fauces, which may be asso­
ciated with well-defined mucous patches. Very often, however, it is
simply a catarrhal redness, sometimes extending into the larynx; there is
frequently a feeling of tenderness and soreness, which is more marked
when mucous patches are present.

As a rule, mucous patches of the mouth are more or less persistent,
unless treated, but will often disappear rapidly under constitutional
measures, and usually promptly under local applications. Occasionally,
especially the opaline, superficial patches of the tongue seem to lead to
a tendency to fissuring, with variable hyperplasia and eventually to well-
marked leukoplakia. As the mucous patch in the mouth is commonly
one of a group of symptoms of syphilis the diagnosis is, as a rule, readily
made. The acuteness, generally sensitive, and evanescent character
of the “aphthous sores” frequently seen in the mouth, and usually asso­
ciated with attacks of indigestion, will serve to distinguish them from the
syphilitic lesions.

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