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

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 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. 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 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 ( Conclusion: 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.