Pinta

Key Features

• Caused by Treponema pallidum subspecies carateum

• Occurs endemically in rural areas of Latin America, especially in Mexico, Colombia, and Cuba, and in some areas of the Pacific

Clinical Findings

• Nonulcerative, erythematous primary papule

  • Spreads slowly into a papulosquamous plaque

  • Shows a variety of color changes (slate, lilac, black)

• Secondary lesions

  • Resemble the primary one and appear within a year after it

  • Appear successively, new lesions together with older ones

  • Occur most common on the extremities

  • Later show atrophy and depigmentation

• Some cases show pigmentary changes and atrophic patches on the soles and palms, with or without hyperkeratosis, that are indistinguishable from "crab yaws"

Diagnosis

• Organisms can be demonstrated in infectious lesions with darkfield microscopy or immunofluorescence but cannot be cultured in artificial media

• Serologic tests for syphilis are positive

Treatment

• Penicillin, 2.4 million units of benzathine penicillin G intramuscularly, is generally curative in any stage of the non–sexually transmitted treponematoses

• In cases of penicillin hypersensitivity, tetracycline, 500 mg orally four times a day for 10–14 days, is the recommended alternative