Pinta is a rare infectious tropical disease affecting the skin that is caused by the bacterium Treponema carateum, which is transmitted by direct, nonsexual contact. Pinta progresses through three distinct stages, which are characterized by various skin lesions and discoloration. Other organ systems are not affected. Exposed areas of the skin such as the face and extremities are most often affected.
Pinta is classified as a treponematosis, which is an infectious disease caused by a treponema. Treponemas are a genus of spiral-shaped bacteria (spirochetes). Treponemas caused several infectious diseases including pinta, yaws, and syphilis.
The symptoms and progression of pinta may vary among affected individuals. Pinta usually progresses in three separate stages: an early phase with initial lesions; an intermediate phase with widespread (disseminated) lesions; and a late phase. The incubation period may range from seven to 21 days. The skin is the only organ involved in pinta.
In most cases, the initial lesions (primary) are small, reddish (erythematous) spots (papules) that occur most often on exposed areas of the arms and legs. The face, neck, chest and abdomen may also be affected. Papules are often itchy (pruritic) and may spread combining to form large plaques. In some cases, nearby lymph nodes may be inflamed (lymphadenitis).
One month to one year after the development of initial lesions, affected individuals may develop secondary skin eruptions called pintids. Pintids are small scaly, reddish lesions that normally affect the same sites as primary lesions. They may be dry and crusted (psoriatic pintids).
Anywhere from three months to a year, secondary lesions and, in some cases, primary lesions may slowly change color from red to brown or slate blue. These lesions may eventually lose their color (depigmentation) becoming white, leaving the skin with a mottled appearance. Pintids may recur for up to 10 years.
The late phase of pinta occurs approximately two to five years after the development of initial lesions and is characterized by white or colorless (achromatic) lesions. During this phase, affected individuals may also develop unusually dry, thickened skin on the soles of the feet and palms of the hands (hyperkeratosis). Eventually, affected individuals may develop dry, wrinkled thin (atrophic) skin in certain areas.
Pinta is an infectious tropical disease caused by the spiral-shaped bacterium (spirochete) known as Treponema carateum.
Pinta affects males and females in equal numbers. Most cases are children or adolescents from endemic areas of the world. It is most common in remote rural tropical areas such as the southern portion of Mexico, Central America and Columbia. It occurs with lower incidence rates in various Caribbean Islands. In recent years, only a few hundred cases of pinta have been reported in the medical literature each year. Pinta does not occur in the United States unless affected individuals have visited endemic areas.
The prevalence of pinta declined greatly following a mass treatment campaign with penicillin by the World Health Organzation (WHO) in the 1950s and 60s. The current incidence of pinta is unknown.
A diagnosis of pinta is suspected based upon a detailed patient history (e.g., recent travel to endemic area), a thorough clinical evaluation, identification of characteristic symptoms, and a variety of tests. These tests may include the microscopic examination of tissue samples (darkfield examination) from the skin lesions of affected individuals. Other blood tests (e.g., VDRL and Treponemal antibody absorption test [FTA-ABS]) usually become positive only after the secondary skin lesions appear.
The treatment for pinta includes antimicrobial drugs. The drug of choice is benzathine penicillin G. A single large dose of this antibiotic usually heals the skin lesions and eliminates the organism. Primary and secondary lesions often heal within six to 12 months; late phase lesions take more time to resolve. Individuals who are allergic to penicillin may be treated with tetracycline or erythromycin.
Drug therapy may also be used to prevent the disease in family members and others who are in frequent contact with affected individuals.
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 website.
For information about clinical trials being conducted at the National Institutes of Health (NIH) in Bethesda, MD, contact the NIH Patient Recruitment Office:
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For more information on research on pinta and other tropical diseases, contact the World Health Organization (WHO) listed in the Resources section below.
Bennett JC, Plum F, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, PA: W.B. Saunders Co; 1996:1714.
Fauci AS, et al., eds. Harrison’s Principles of Internal Medicine, 14th Ed. New York, NY: McGraw-Hill, Inc; 1998:1035-6.
Mandell GL, et al., eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone Inc; 1995:2135-6.
Champion RH, et al., eds. Textbook of Dermatology. 5th ed. Cambridge, MA: Blackwell Scientific Publications; 1992:1121-5.
Antal GM, Lukehart SA, Meheus AZ. The endemic treponematoises. Microbes Infect. 2002;4:83-94.
Koff AB, Rosen T. Nonvenereal treponematoses: yaws, endemic syphilis, and pinta. J Amer Acad Dermatol. 1993;29:519-35.
Meheus A, Antal GM. The endemic treponematoses: not yet eradicated. World Health Stat Q. 1992;45:228-37.
Antal GM, Causse G. The control of endemic treponematoses. Rev Infect Dis. 1985;7:S220-6.
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Klein NC. Pinta. Emedicine. 2004. Available at: http://www.emedicine.com/med/topic1836.htm Accessed on: February 1, 2005.