A cluster of scars radiating around the mouth is called rhagades. White mucous patches may be found on any of the mucous membranes. Ectodermal changes include exfoliation of the nails, loss of hair and eyebrows, and iritis. Late manifestations of congenital syphilis are the result of scarring from the early systemic disease and include involvement of the teeth, bones, eyes, and gummas in the viscera, skin, or mucous membranes. Characteristic changes of the teeth include a notched appearance on the biting edges of the upper central incisors, these are called Hutchinson's teeth.
Interstitial keratitis is the most common late lesion.
A ground glass appearance may develop in the cornea accompanied by vascularization of the adjacent sclera. Bony changes include sclerosing lesions, saber shin, frontal bossing and gummatous or destructive lesions within long bones. If central nervous system involvement cannot be excluded treatment should be given for 10 days. Infants born to mothers who received adequate penicillin treatment for syphilis during pregnancy are at minimal risk for congenital syphilis, but they should be examined carefully and at frequent intervals until the serologic test results are negative. Infants should be treated if maternal treatment was inadequate, was unknown, or was given during the last 4 weeks of pregnancy, or was with drugs other than penicillin.