Pinta
Pinta is a rare bacterial infection caused by the spirochete Treponema pallidum carateum, primarily affecting individuals in remote rural areas of Central and South America. It is transmitted through close, nonsexual contact involving skin or mucous membranes, and most cases are reported in disadvantaged populations with poor hygiene and crowded living conditions. Pinta manifests as chronic skin lesions that can appear in stages, starting with erythematous papules and potentially evolving into disfiguring atrophic lesions over time. While not fatal, the disease can result in significant social stigma due to its visible effects.
Individuals aged fifteen to thirty are most commonly affected, with both men and women equally at risk. Diagnosis is typically based on the appearance of skin lesions and may include serologic testing for antibodies. Treatment usually involves a single injection of benzathine penicillin, which renders the lesions noninfectious within 24 hours. Preventive measures focus on good hygiene practices and reducing physical contact with infected individuals, alongside improving sanitation and access to healthcare in endemic regions.
Pinta
- ANATOMY OR SYSTEM AFFECTED: Skin
- ALSO KNOWN AS: Azul, carate, mal de pinto
Definition
Pinta is a rare, endemic, treponemal bacterial infection characterized by chronic skin lesions that occur primarily in young adults. Pinta, with yaws and endemic syphilis, are the three chronic granulomatous diseases that constitute the group of pathogenic nonvenereal (nonsexual) treponematoses in humans.
Causes
Pinta is caused by the spirochete bacterium Treponema pallidum carateum. The disease is contagious and spread from person to person through close, prolonged, nonsexual contact involving skin or mucous membranes.
Risk Factors
Pinta occurs in scattered foci in remote rural areas of Central America, South America, Mexico, and Caribbean countries, where poor hygiene and crowded conditions exist, primarily among disadvantaged persons. Though the exact prevalence of the disease is unknown, it is considered a rare disorder. According to the Cleveland Clinic in 2023, only a few hundred cases are reported each year across the world.
Pinta affects children and adults of all ages, but the peak age of incidence is fifteen to thirty years. Women and men are equally affected, and the disease is frequently spread to family members. Economically underprivileged peoples with frequent skin trauma, limited protective clothing, and little or no access to health care are at increased risk.
Symptoms
Pinta is classified into an early stage (with initial and secondary lesions) and a late stage (latent phase and tertiary stage). The initial skin lesion usually appears after an incubation period of two to three weeks. It begins as one or more erythematous papule most frequently found on exposed parts of the body (legs, dorsum of the foot, forearm, and hands). The lesion slowly enlarges and becomes pigmented and hyperkeratotic. It may be accompanied by regional lymphadenopathy.
The secondary lesions appear between one and twelve months of the primary lesion. They vary in size and location, become pigmented with age, may change colors; several colors may exist within the same lesion. Late or tertiary pinta usually begins several years after the onset of the disease and is characterized by disfiguring achromic and atrophic lesions. Pinta is the most benign among the spirochetal diseases because it has skin manifestations only.
Neurologic, bone, or cardiac manifestations do not occur, and no congenital form of the disease exists. Pinta is not a fatal disease, but it is a disfiguring one that often leads to social ostracism.
Screening and Diagnosis
Diagnosis is based on the lesions’ appearance and on microscopical examination. Also available is serologic testing for T. carateumantibodies.
Treatment and Therapy
Pinta can be treated with a single dose of azithromycin or benzathine penicillin G. Adults are treated with a single intramuscular administration in two injection sites. Children are treated with a single dose. After this treatment, lesions become noninfectious in twenty-four hours. Alternative therapies for persons who are allergic to penicillin include tetracycline and erythromycin.
The prognosis for persons with pinta is good. Primary and early secondary lesions may take four to six months to disappear. Late secondary lesions heal slowly, within six to twelve months. Pigmentary changes in late lesions may persist.
Prevention and Outcomes
Good personal hygiene is the main preventive measure. Children should avoid physical contact with persons who have skin lesions caused by pinta. Improvement of sanitation, access to antibiotics in endemic rural areas, and campaigns against infection are essential for the eradication of this infectious disease.
Bibliography
Antal, George M., Sheila A. Lukehart, and Andre Z. Meheus. “The Endemic Treponematoses.” Microbes and Infection 4 (2002): 83-94.
Feigin, Ralph D., et al., eds. Textbook of Pediatric Infectious Diseases. 6th ed. Philadelphia: Saunders/Elsevier, 2009.
Nassar, Naiel N., and Justin David Radolf. “Nonvenereal Treponematoses: Yaws, Pinta, and Endemic Syphilis.” In Kelley’s Textbook of Internal Medicine, edited by H. David Humes et al. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2000.
"Pinta." Cleveland Clinic, 20 June 2024, my.clevelandclinic.org/health/diseases/25091-pinta. Accessed 4 Feb. 2025.