The Herxheimer reaction, first described in 1902, manifests itself in exacerbating syphilitic lesions associated with inflammatory changes which are most frequently produced by antisyphilitic therapy with mercury, arsphenamin or bismuth.
As the syphilitic lesions of the skin and mucous membrane are most pronounced, it is evident that the Herxheimer reaction is best known in association with these lesions.
The primary lesions, the localized secondary manifestations of syphilis, the severe skin affections in malignant syphilis and the tertiary lesions in general do not give such severe nor such readily recognizable reactions as the widespread exanthems of the secondary stage. In this stage, the reaction manifests itself in its most characteristic form, presenting lesions of the skin associated with hyperemia and edema. In a typical mild case, exanthems may appear immediately after the first treatment and "cure" when a sufficient dose has been administered. The most characteristic picture of the reaction includes