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.

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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.

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The regional lymph nodes may enlarge.

Lesions become pigmented with time 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.

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Approximately 3-9 months after infection, more lesions may appear distal to the initial lesion and expand. Late lesions become treponeme-free and achromic or treponeme-containing and 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.

Differential Diagnoses

Media Gallery

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.
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.
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.

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Author

Nelson Ivan Agudelo Higuita, MD, DTM&H, CTH® Edith Kinney Gaylor Presidential Professor, Associate Professor, Program Director, Infectious Diseases Fellowship Program, Medical Director, Refugee and Travel Clinic, Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Sciences Center; Attending Physician, Infectious Diseases Consultation Service, Department of General Internal Medicine, Oklahoma University Medical Center

Nelson Ivan Agudelo Higuita, MD, DTM&H, CTH® is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Brian Scott, DO Fellow, Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Sciences Center

Brian Scott, DO is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Transplantation, Infectious Diseases Society of America, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard B Brown, MD, FACP Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Natalie C Klein, MD, PhD Associate Director, Infectious Disease Division, Associate Professor of Medicine, The School of Medicine at Stony Brook University Medical Center

Natalie C Klein, MD, PhD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, New York County Medical Society, American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio

Disclosure: Received research grant from: Regeneron.

Kathy Hoang, MD Fellow, Department of Internal Medicine, Infectious Diseases Section, Oklahoma University Health Sciences Center

Kathy Hoang, MD is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.