Background
Pinta is an endemic treponematosis caused by Treponema carateum. [1] It is an ancient disease that was first described in the 16th century in Aztec and Carib Amerindians. [2] Pinta is characterized by chronic skin lesions that occur primarily in young adults. [3, 4, 5, 6]
The name pinta originates from the Spanish word for "painted." The disease is known by different names in different regions. For example, it is known as mal de pinto in Cuba and Mexico, enfermedad azul (blue sickness) in Chile and Peru, and carate in Colombia and Venezuela. [7]
Pathophysiology
The precise mechanism of transmission is unknown, although recurrent skin-to-skin contact is most plausible. Pinta is not known to be a blood-borne disease or to be transmitted vertically. Young adults with pinta skin lesions are considered to be the disease's main reservoir. [7, 8]
Like other treponematoses, pinta is classified into stages. The infection is thought to be limited to the epidermal and dermal layers despite systemic dissemination, although potential bone involvement has been reported. [9]
After an incubation period that ranges from 1 week to 2 months, the initial lesion appears on the skin. The primary lesion is a papule or erythematous and squamous plaque usually found on exposed surfaces of the legs, dorsum of the foot, forearm, or hands. The lesion enlarges slowly and becomes pigmented and hyperkeratotic and may last months or years. It is often accompanied by regional lymphadenopathy.
The secondary stage is characterized by disseminated lesions, referred to as pintids. The lesions appear after several months and may coexist with the primary lesion. Pintids are similar to the primary lesion and can vary in size and location and usually become pigmented with time. The primary and secondary lesions are rich in bacteria and are considered highly infectious. [4, 5, 6, 7, 8]
Late or tertiary pinta usually develops 2-5 years after the initial infection. Late 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. [1, 2, 3, 6, 7]
Epidemiology
Frequency
United States
Pinta does not occur in the United States.
International
It is unclear whether pinta still occurs in scattered foci in rural areas of Central and South America. [10]
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. Today, it is unclear whether pinta still exists. If so, it might be restricted to very circumscribed parts of Latin America; known recent foci have involved the Tikuna tribes living in the Amazon Trapeze and inhabitants of a Panamanian village. Until recently, the most recently reported case of pinta involved a Cuban female who was visiting Austria in 1999. [2, 7, 11, 12] A report from 2020 describes an autochthonous case in southern Brazil. [13]
Mortality/Morbidity
Pinta is the most benign of the endemic treponematoses. The skin is the only organ involved.
No neurologic or cardiac manifestations occur. No congenital form is known to exist.
Sex
Both sexes are affected with equal frequency.
Age
Pinta affects children and adults of all ages. [14]
The peak age of incidence is 15-30 years.
Prognosis
The prognosis is good. The skin is the only organ affected. Primary and secondary lesions usually heal within 6-12 months. Pigmentary changes persist in late lesions.
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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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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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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.
