eMedicine Specialties > Infectious Diseases > Skin and Soft-Tissue Infections
Pinta
Updated: Nov 4, 2009
Introduction
Background
Pinta is an endemic treponematosis caused by Treponema carateum. It is an ancient disease that was first described in the 16th century in Aztec and Carib Amerindians. In 1938, treponemes indistinguishable from those that cause yaws and syphilis were demonstrated in lesions of a Cuban patient. Pinta is characterized by chronic skin lesions that occur primarily in young adults.
Pathophysiology
Like other treponematoses, pinta is classified into an early and late stage. The early stage comprises the initial lesion and the secondary lesions, while the late stage comprises the latent phase and tertiary stage.
After an incubation period of approximately 2-3 weeks, the initial lesion appears on the skin. The primary lesion is a papule or erythematosquamous plaque usually found on exposed surfaces of the legs, dorsum of the foot, forearm, or hands. The lesion slowly enlarges and becomes pigmented and hyperkeratotic. It is often accompanied by regional lymphadenopathy.
Disseminated lesions, referred to as pintids, are similar to the primary lesion and may appear 3-9 months after infection. These secondary lesions vary in size and location and become pigmented with age.
Late or tertiary pinta is characterized by disfiguring pigmentary changes, hypochromia, achromic lesions, and hyperpigmented and atrophic lesions. The pigmentary changes often produce a mottled appearance of the skin. Lesions may appear red, white, blue, violet, and brown.
Frequency
United States
Pinta does not occur in the United States.
International
Pinta occurs in scattered foci in rural areas of Central and South America. In the 1950s, about 1 million cases of pinta were reported in Central and South America. In the 1980s, 20% seropositivity was found in remote rural areas of Panama. The current prevalence of pinta is unknown, but only a few hundred cases have been reported per year.
Mortality/Morbidity
- Pinta is the most benign of the endemic treponematoses. The skin is the only organ involved.
- No neurologic, bone, or cardiac manifestations occur. No congenital form exists.
Sex
Both sexes are affected with equal frequency.
Age
- Pinta affects children and adults of all ages.
- The peak age of incidence is 15-30 years.
Clinical
History
- The exact mode of transmission is unknown, but pinta is probably transmitted by direct skin or mucous membrane contact.
- The initial lesion is usually found on an exposed part of the body.
- Pinta causes no constitutional symptoms.
Physical
The initial lesion is a papule that slowly enlarges to become a pruritic plaque (as seen in the image below).
Erythematosquamous plaque of early pinta. Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.
The dorsum of the foot and legs are the most common sites of lesions (as seen in the image below).
Violaceous psoriatic plaque of early pinta. Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.
The regional lymph nodes may enlarge.
Lesions become pigmented with age and may change colors from copper to grey to slate blue (as seen in the image below).
Late pigmented pinta (blue variety). Perine PL, Hopkins DR, Niemel PLA, et al. Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis, and Pinta. Geneva, Switzerland: World Health Organization; 1984.
Late lesions become achromic or hyperpigmented.
Causes
- T carateum is the causative agent and is considered to be a separate species from Treponema pallidum.
- T carateum can be grown only in primates, and less is known about this treponeme than any of the others.
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References
Antal GM, Lukehart SA, Meheus AZ. The endemic treponematoses. Microbes Infect. Jan 2002;4(1):83-94. [Medline].
Chulay JD. Treponema Species (Yaws, Pinta, Bejel). In: Mandell, Douglas, Bennett eds. Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, Pa: Churchill Livingstone; 2000:(2)2490-4.
Engelkens HJ, Niemel PL, van der Sluis JJ, Meheus A, Stolz E. Endemic treponematoses. Part II. Pinta and endemic syphilis. Int J Dermatol. Apr 1991;30(4):231-8. [Medline].
Engelkens HJ, Vuzevski VD, Stolz E. Nonvenereal treponematoses in tropical countries. Clin Dermatol. Mar-Apr 1999;17(2):143-52; discussion 105-6. [Medline].
Farnsworth N, Rosen T. Endemic treponematosis: review and update. Clin Dermatol. May-Jun 2006;24(3):181-90. [Medline].
Giuliani M, Latini A, Palamara G, Maini A, Di Carlo A. The clinical appearance of pinta mimics secondary syphilis: another trap of treponematosis?. Clin Infect Dis. May 15 2005;40(10):1548; author reply 1548-9. [Medline].
Hook III EW. Treponemal infections. In: Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases: Principles, Pathogens, and Practice. Philadelphia, Pa: Churchill Livingstone; 1999:527-34.
Lupi O, Madkan V, Tyring SK. Tropical dermatology: bacterial tropical diseases. J Am Acad Dermatol. Apr 2006;54(4):559-78; quiz 578-80. [Medline].
Morand JJ, Simon F, Garnotel E, Mahé A, Clity E, Morlain B. [Overview of endemic treponematoses]. Med Trop (Mars). Feb 2006;66(1):15-20. [Medline].
Parish JL. Treponemal infections in the pediatric population. Clin Dermatol. Nov-Dec 2000;18(6):687-700. [Medline].
Rothschild B. Pinta: specific disease or anomalous skin reaction?. Clin Infect Dis. Sep 15 2005;41(6):914. [Medline].
Woltsche-Kahr I, Schmidt B, Aberer W, Aberer E. Pinta in Austria (or Cuba?): import of an extinct disease?. Arch Dermatol. Jun 1999;135(6):685-8. [Medline].
Further Reading
Keywords
pinta, azul, carate, endemic treponematosis, mal de pinto, Treponema carateum, T carateum, skin lesions, treponemes, pintids
