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
(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.
(1) malocclusion with open bite
(2) frontal bossing (involving the frontal bone)
(3) saddle nose
(4) poorly developed premaxilla
(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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Specialty: Otolaryngology, Infectious Diseases, Pedatrics