# Clinical and trichoscopic features of early congenital syphilis: a single-center cross-sectional study

## TL;DR

This study identifies specific hair abnormalities in neonates with early congenital syphilis that correlate with higher disease activity, suggesting trichoscopy as a useful non-invasive diagnostic tool.

## Contribution

The study is the first to systematically describe trichoscopic features of early congenital syphilis and link them to serological markers.

## Key findings

- Syphilitic alopecia was found in 23.3% of neonates with early congenital syphilis.
- Exclamation mark and coudability hairs were most strongly associated with elevated VDRL titers.
- Trichoscopy revealed hair shaft abnormalities like broken hairs and Pohl–Pinkus constrictions in affected neonates.

## Abstract

Early congenital syphilis (ECS) remains an emerging public health problem in Latin America. Syphilitic alopecia (SA) is a rare and underreported manifestation in neonates, and its trichoscopic characteristics have not yet been systematically described.

We have conducted a 1-year cross-sectional analytical study involving 30 neonates diagnosed with ECS, classified into clinical–serological scenarios 1 and 2 according to the Centers for Disease Control and Prevention (CDC) criteria, who were hospitalized at a tertiary care center in Guadalajara, Mexico. Sociodemographic, clinical, and serological data were collected. The presence of SA and associated trichoscopic findings was recorded. Neonates were stratified according to non-treponemal titers into two groups [<1:128 vs. ≥1:128 and/or the prozone phenomenon (PP)]. Associations were evaluated using the chi-squared test or Fisher’s exact test, as appropriate. Logistic regression models were used to examine the association between trichoscopic characteristics and elevated neonatal Venereal Disease Research Laboratory (VDRL) titers.

Thirty neonates were included, yielding an ECS prevalence of 3.05%. The vast majority of patients were male (76.7%) and were classified as CDC scenario 2 (70%). SA was identified in 23.3% of cases and was significantly associated with VDRL titers ≥1:128 or the presence of a prozone phenomenon (p = 0.006; odds ratio [OR]: 11.9; 95% confidence interval [CI]: 1.67–84.50). The most frequent trichoscopic abnormalities were exclamation mark hairs, coudability hairs, broken hairs, zig-zag/angulated hairs and Pohl–Pinkus constrictions. Among these abnormalities, exclamation mark and coudability hairs have shown the strongest associations with elevated neonatal VDRL titers.

Trichoscopy enabled the identification of specific hair shaft abnormalities associated with increased serological activity, supporting its value as a complementary, non-invasive diagnostic tool in pediatric dermatology for evaluating neonates with ECS.