Early congenital syphilis (ECS) remains a public health problem in Latin America, and syphilitic alopecia (hair loss) is its rare manifestation in newborns. The study included 30 newborns diagnosed with ECS, of which 76.7% were boys and 70% were classified as CDC scenario 2. Syphilitic alopecia occurred in 23.3% of patients and was significantly associated with higher VDRL values (≥1:128) or the presence of the prozone phenomenon (odds ratio 11.9). The most common trichoscopic abnormalities (changes seen by microscopic examination of the hair) were exclamation mark hairs, curly hairs, broken hairs and zigzag patterns. Exclamation mark and curly hair showed the strongest association with elevated serological values in newborns. Trichoscopy has been shown to be a useful, noninvasive diagnostic tool for identifying specific changes in the hair shaft associated with increased infection activity in newborns with congenital syphilis.