Congenital syphilis presenting as desquamative dermatitis

During the last 5 years the incidence of congenital syphilis has increased several-fold and reached epidemic proportions. This increase is directly related to a similar increase in cases of primary and secondary syphilis in women and has been linked to the use of "crack" cocaine. Factors responsible for the increase in reported cases of congenital syphilis include poor prenatal care, implementation of new surveillance case definition, failure to perform serological tests, treatment failures with benzathine penicillin, and maternal reinfection. Clinical manifestation of congenital syphilis are multisystemic but are often absent at birth. We report a case of congenital syphilis missed at birth and later characterized by prominent desquamative dermatitis affecting most of the skin surface.