Description, Causes and Risk Factors:
A disease caused by a Spirochete, Treponema carateum, endemic in Mexico and central America, and characterized by a small primary papule followed by an enlarging plaque and disseminated secondary macules of varying color called pintids that finally become white.
Pinta is a very old disease, known to the advanced native civilization of Mexico and central America. Today, it is uncommon, found only in remote areas of southern Mexico, central America, and northern America. Several hundred cases are reported yearly, a marked reduction from two decades ago.
Infection occurs through minor skin breaks. The treponemes then multiply locally and systemically just as with T. pallidum.
Since there are no systemic findings, Pinta is less serious than the other treponemal disease. Patients, however, find the pigmentary changes very distressing. Lesions are similar to melasma, which is also extremely common in the same populations. In the late stage, the main questions are Vitiligo and leprosy, which also occurs in some of the same areas.
The inoculation period is about 21 days.
The initial lesion is a smooth papule, usually on the extremities. Sometimes several grouped papules appear and then coalesce into a large plaque, many centimeters in diameter, with a distinct raised border. While ulceration is uncommon, the primary lesion or lesions may persist for months to years before healing with a hypopigmented scar. The secondary lesions appear 3-12 months after the appearance of the initial lesion; this means that, frequently, primary and secondary lesions are present simultaneously. The secondary lesions are small papules known as pintids, which heal slowly with dyschromic changes, producing white, gray, blue and brown flat macules. Pintids may continue to appear over many years. The primary and secondary lesions contain spirochetes. In the late stage, there are no destructive lesions but instead persistent hypo or depigmentation, especially on the distal aspects of the arms and legs. There are no skeletal, cardiovascular, or CNS changes.
Dark-field examinations are positive in the early stages. The serologic tests for syphilis become positive in the secondary stages and remain positive for Life.
Histopathology. The early lesions are psoriasiform or often more lichenoid with infiltrates impinging on the epidermal-dermal junction. Plasma cells are prominent, as is vesicular involvement. In the depigmented lesions, there is marked incontinence of pigment but residual melanocytes and occasional plasma cells, which may allow a distinction from Vitiligo, in which melanocytes are lacking.
A single IM injection of benzathine penicillin G is curative. The early lesion clear in 4-6 months, while later lesions required longer and usually leave residual hypopigmentation. Totally depigmented lesions are not typically influenced by therapy. Once again, when a case is identified, mass inoculations of entire villages have been effective in reducing the impact of the disease.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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