A number of stigmata may be found in patients with congenital syphilis. Identification of these findings should prompt serologic testing for syphilis.


Classes of findings:

(1) postrhagadic scarring and syphilitic rhagades about the mouth

(2) dental changes in the permanent teeth

(3) dentofacial abnormalities


Peri-oral scarring:

(1) linear scars/wrinkles radiating from the angles of the mouth

(2) linear scars/wrinkles extending down from the lower lip



• Syphilic lesions may be noted at a younger age than that expected for age-related wrinkling.

• Nonsyphilitic wrinkles tend to increase with age and tend to follow the natural skin creases.


Changes in the permanent dentition related to dental hypoplasia:

(1) increased spacing of teeth along the maxilla

(2) incisors: notched, "screwdriver", peg-shaped

(3) canines: rounding of the tip

(4) first molars: "mulberry" molar (bud-shaped from moving the cusps towards the center of the crown)



• The dental changes may be identified in dental X-rays prior to eruption of the permanent teeth.


Dentofacial abnormalities:

(1) malocclusion with open bite

(2) frontal bossing (involving the frontal bone)

(3) saddle nose

(4) poorly developed premaxilla


Other findings:

(1) The combination of dental changes in the incisors, eight nerve deafness and interstitial keratitis is termed Hutchinson's triad. The occurrence of all 3 findings is rare.



• Most of these changes are individually not specific for congenital syphilis. But the presence of multiple findings increases diagnostic certainty.


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