Pinta

Pinta is a non-venereal treponemal skin infection caused by Treponema carateum, confined to the skin without systemic or bone involvement.

• Endemic in remote regions of Mexico, Central America (Panama), and South America (Colombia, Venezuela, Peru, Ecuador, Brazil).
• Spread by direct skin contact, mainly in children and young adults from poor, rural areas.
• Rare; around 1 million cases worldwide in the past but almost eradicated.

• Primary: an erythematous papule or plaque on exposed skin (legs, arms, face), with regional adenopathy, persisting for months.
• Secondary (pintids): multiple scaly erythematous or slate blue plaques 3 to 12 months later, leading to dyschromic changes.
• Late (tertiary): symmetrical depigmented, white (vitiligo like), or hyperpigmented patches ("pinta" means painted), with atrophy, mostly on the extremities.
• Itch can occur; no neurological or cardiovascular involvement.

• Clinical, based on appearance and geographic exposure.
• Dark field microscopy of scrapings from early lesions (treponemes visible), and biopsy showing acanthosis and perivascular lymphoplasmacytic infiltrate.
• Serology reactive in non-treponemal (VDRL, RPR) and treponemal tests (cannot distinguish from other treponematoses).
• Exclude vitiligo, tinea versicolor, leprosy, syphilis, yaws, pityriasis alba, and psoriasis.

• Benzathine penicillin G single IM dose: 1.2 million units for adults and 0.6 million units for children.
• Alternative: azithromycin 2 g orally in a single dose (extrapolated from yaws), doxycycline 100 mg twice daily for 14 days in penicillin allergy.
• Early lesions heal and serology (VDRL) falls after treatment; late depigmented lesions persist.
• Treatment of contacts and community.
• Follow up with serological monitoring at 6 and 12 months.