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Last updated: 4/16/2025
Years published: 1986, 1994, 2005, 2025
NORD gratefully acknowledges Gioconda Alyea, MD (FMG), MS, National Organization for Rare Disorders, for assistance in the preparation of this report.
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Introduction
Pinta, also called puru-puru or carate, is a chronic skin disease that mainly affects people living in tropical rural areas, especially in Latin America. It is caused by a type of bacteria called Treponema carateum. Pinta doesn’t affect internal organs, only the skin, which makes it the mildest of a group of related diseases called “endemic treponematoses.” These also include yaws and bejel. While pinta has become extremely rare over the past several decades due to widespread antibiotic treatment, it may still exist in remote areas.1
Signs and symptoms develop in 3 stages that start with small lesions that become permanent white patches in the third stage. Doctors diagnose pinta by examining the skin and reviewing the patient’s history, especially travel to regions where pinta was common.
Pinta infection is cured by antibiotics.1
Pinta involves only skin. The signs and symptoms develop in three stages:1,2,3,4
Lesions of primary and secondary pinta are highly infectious.6
Although pinta causes noticeable skin changes, it doesn’t damage bones or organs like other similar diseases can.
Pinta is caused by a spiral-shaped bacterium called Treponema carateum. This bacterium is closely related to those that cause syphilis, yaws and bejel. Pinta is not sexually transmitted. Instead, it spreads through direct skin-to-skin contact with someone who has the disease, usually among children in communities with poor hygiene and limited healthcare access.1,7 Insect bites can also transmit the disease, since they break the skin.2
Pinta was first described in the 16th century in Aztec and Caribbean Amerindians, and it was once widespread in Mexico, Central America and parts of South America. Large treatment campaigns in the mid-20th century led to a dramatic decline in cases and currently, pinta is only found in scattered rural areas of Central and South America. In the 1950s, about 1 million cases of pinta were reported and currently only a few hundred cases are reported per year.2
While some think that pinta is extinct, the last reported case of pinta was reported in 2020, suggesting the disease may still exist in remote areas.1
Doctors in the U.S. should be aware of pinta when evaluating children and adolescents from regions where the disease was once common, especially if they test positive on syphilis blood tests.1 Pinta primarily affects children and young adults.2
Doctors diagnose pinta by examining the skin and reviewing the patient’s history, especially travel to regions where pinta was common. The diagnosis is usually made based upon the appearance of the lesions.
There is no specific laboratory or histopathologic test that uniquely identifies Treponema carateum, the bacteria that causes pinta.
Blood tests for syphilis (called serologic tests) often turn positive during later stages of pinta because the available laboratory tests cannot tell the difference between Treponema carateum, the specific Treponema that causes pinta and the other types of Treponema that cause yaws and syphilis.2
In early pinta lesions, skin biopsy, a procedure where a small sample of the skin is removed and analyzed, may show spiral-shaped Treponema bacteria (treponemes), but is not specific to the Treponema carateum. These can sometimes be seen under darkfield microscopy, although this technique is more commonly used in syphilis.1 Silver staining methods can also reveal treponemes in tissue samples but also are not specific to the Treponema carateum. 2 This means that serologic tests and microscopy can’t differentiate between treponemal diseases.
Polymerase chain reaction (PCR) is a lab test that works by finding and copying tiny amounts of the genetic material (DNA) in a skin sample or other tissue that can be used to look for the DNA of the bacteria that cause pinta.
For diseases like pinta, PCR could help to differentiate between similar infections like syphilis or yaws. However, this test isn’t commonly available in most clinics, especially in areas where pinta usually happens. It’s currently used mostly in research or specialized labs.
Therefore, while PCR has the potential to be more accurate, most people with pinta are still diagnosed based on symptoms, appearance of the skin and simple blood tests that check for any treponemal infection, not just pinta.
Treatment
Pinta is treated with a single shot of benzathine penicillin G, an antibiotic, which is usually enough to clear the infection. The dose is adjusted for children. People allergic to penicillin can take alternatives like tetracycline, doxycycline, azithromycin or erythromycin.1,4,5
The World Health Organization (WHO) recommends treatment of pinta with a single-dose intramuscular injection of long-acting benzathine penicillin (1.2 MU for adults; 0.6 MU for children). Skin lesions become non-infectious within 24 hours of treatment.3
Early lesions heal within 6 to 12 months, 2,5-12 but late-stage skin changes, like white skin patches, may be permanent.1, 2
It is also recommended to treat others who had close contact with the person with pinta with antibiotics.5,6,7,8,9
After treatment, nontreponemal titers (antibodies) should decline and can (but do not always) revert to negative.3
The WHO started a campaign to eradicate yaws (caused by T pallidum pertenue) by 2020 based on the mass treatment of endemic communities with an oral dose of azithromycin. T carateum is most likely sensitive to azithromycin, and this intervention could therefore have a similar effect on pinta in regions of Latin America where both yaws and pinta might still coexist. As of 2023, these efforts are ongoing; the WHO recommends integrating yaws eradication activities with neglected tropical disease (NTD) programs. The WHO published a framework on integrated control of skin NTDs in June 2022 to assist countries with eradication efforts.3
For more information on research on pinta and other tropical diseases, contact the World Health Organization (WHO) listed under Organizations below.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: [email protected]
Some current clinical trials also are posted on the following page on the NORD website:
https://rarediseases.org/living-with-a-rare-disease/find-clinical-trials/
For information about clinical trials sponsored by private sources, contact: www.centerwatch.com
For information about clinical trials conducted in Europe, contact: https://www.clinicaltrialsregister.eu/
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