ORIGINAL RESEARCH article
Front. Med.
Sec. Dermatology
Clinical and trichoscopic features of early congenital syphilis: A single-center cross-sectional study
Cuauhtli Emmanuel Arambul-Carrillo 1,2
Luis Enrique Sánchez-Dueñas 3,2
Rocío Concepción Albores-Arguijo 1,2
Yocelin Nallely Lozano-Figueroa 1,2
María Guadalupe Castro-Mosqueda 2
Jessica Aranda-Mendoza 2
1. Antiguo Hospital de Civil de Guadalajara-Fray Antonio Alcalde, Guadalajara, Mexico
2. Universidad de Guadalajara, Guadalajara, Mexico
3. Instituto Dermatologico de Jalisco Dr Jose Barba Rubio, Zapopan, Mexico
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Abstract
Introduction: 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. Methods: We have carried out a one-year cross-sectional analytical study involving 30 neonates diagnosed with CSE classified in clinical-serological scenarios 1 and 2 according to the criteria of the Centers for Disease Control and Prevention (CDC), who were hospitalized in a tertiary care center in Guadalajara, Mexico. Sociodemographic, clinical, and serological data were collected. The presence of SA and associated trichoscopic findings were recorded. Neonates were stratified according to non-treponemal titers into two groups (<1:128 vs. ≥1:128 and/or the prozone phenomenon). Associations were evaluated using the chi-square test or Fisher's exact test, as appropriate. Logistic regression models were performed to explore the relationship between trichoscopic characteristics and elevated neonatal VDRL titers. Results: 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 stage 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; OR 11.9; 95% CI: 1.67-84.50). The most frequent trichoscopic abnormalities were exclamation mark hairs, caudability hairs, broken hairs, zig-zag/angulated hairs,, and Pohl-Pinkus constrictions. Among these, exclamation mark and caudability hairs showed the strongest associations with elevated neonatal VDRL titers. Conclusion: Trichoscopy allowed 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 the evaluation of neonates with ECS.
Summary
Keywords
Alopecia, Congenital syphilis, Syphilis, Syphilitic alopecia, Trichoscopy
Received
17 November 2025
Accepted
26 January 2026
Copyright
© 2026 Arambul-Carrillo, Sánchez-Dueñas, Albores-Arguijo, Lozano-Figueroa, Castro-Mosqueda and Aranda-Mendoza. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Cuauhtli Emmanuel Arambul-Carrillo
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