Introduction

Pinta is a rare chronic skin disease first described in the 16^th century in Mexico. It is caused by a bacterium called Treponema carateum.¹ The word Pinta means painted, and it originated from Spanish.² Research tells us that it was extinct in some South and Central American areas. Later, the symptoms of Pinta were seen in some people.³ Before learning about the symptoms, let us first know what the Treponema bacteria are.

Treponema: It can be classified into Treponema pallidum, Treponema pertenue, Treponema endemicum, and Treponema carateum. Except for T. pallidum, all other diseases are caused non-verbally. In the 1940s, it was discovered that T. pallidum is sensitive to penicillin G, and it was found to be effective in eradicating syphilis in all clinical stages as well as congenital infection.⁴

Transmission of Pinta: It is nonverbal and occurs from human to human, skin to skin. The cases are mostly seen in children and adolescents.⁴ The bacteria enter the skin through a small cut or scratch.

Development and stages

Pinta only affects the skin. The primary lesion is usually psoriasiform in appearance. The lesions attain a diameter of several centimetres and could be violet in colour at their initial stage:⁵

• Lesions and satellite lesions grow over months, forming scaly plaques. After 2 to 18 months, secondary lesions emerge with ulcers and hyperchromic patches. Hands, feet, and scalp are typically affected⁴
• Pinta’s late stages show hyperchromia, achromia, acanthosis, and atrophy. Healing leads to hyperpigmentation, then depigmentation, and hyperkeratosis due to scarring⁴
• Treponemes affect melanin, causing skin signs in 2-5 years. Stages overlap, lacking a clear distinction⁴

Symptoms

• It begins with flat, itchy, and red patches on various body parts like hands, feet, legs, arms, face, or neck²
• After a few months, similar areas on both sides of the body, especially where bones are close to the skin, develop slate-blue patches²
• These patches eventually lose their colour over time²
• The condition leads to thickening of the skin on the palms and soles²

Complications

• Late complications are non-destructive, dyschromic macules
• VDRL positive, Hypo pigmentation, Gumma, skin ulceration, and facial ulcers are some of the other complications of Pinta²

Diagnosis

• The diagnosis of the condition involves assessing geographic factors, evaluating clinical manifestations, and identifying causative organisms through exudate analysis⁴
• To confirm the disease, a serological test is performed. The test helps to indicate that the body has mounted an immune response against the disorder agent. Serology is the study of blood and specifies the presence of antibodies⁴
• This multifaceted approach ensures a comprehensive and accurate understanding of the patient’s condition, aiding effective treatment and management⁴
• Other clinical tests are general physical examination and dermatological examination⁶

Management

• Improvement in personal and domestic hygiene²
• Essential measures include a sufficient water supply and improving housing conditions
• Travellers should avoid skin contact with other infected people
• Conducting various health education programs and awareness
• Continuous surveillance integrated into primary health care is necessary to identify and treat new cases, contacts, and treatment failures²

Treatment

• The only treatment is Penicillin treatment
• In non-penicillin-allergic patients without central nervous system involvement, use benzathine penicillin G for infection treatment. It is a long-acting penicillin that maintains effective levels in serum for up to 10 days⁴
• Younger patients are advised to take erythromycin⁵
• Patients who are sensitive to penicillin should receive tetracycline⁵

One should visit the nearest healthcare centres if any of the symptoms or conditions are visible in a person.

Summary

Pinta is a chronic skin disease with historical roots dating back to the 16^th century in Mexico, caused by the bacterium Treponema carateum. Despite its apparent disappearance from certain South and Central American regions, sporadic cases have emerged over time. Treponema bacteria include various types. The only known treatment for treponema was penicillin G. Pinta’s transmission is nonverbal. The primary treatment for this condition is Penicillin. For patients not allergic to penicillin and without central nervous system issues, benzathine penicillin G is recommended as it remains effective in the bloodstream for around 10 days. Younger individuals should consider erythromycin, while those sensitive to penicillin can opt for tetracycline.

The initial stages of the condition involve the appearance of flat, itchy, and red patches on the body. This condition also causes thickening of the skin on the palms and soles.

The sole treatment is penicillin. Diagnosis involves considering geographical factors, evaluating symptoms, and analysing exudate to identify the causing organisms. Confirmation is done through serological tests, indicating an immune response via antibodies in the blood. This comprehensive approach ensures a precise understanding for effective management. Additional clinical tests include physical, neurological, dermatological, and neuro-ophthalmological examinations. One should visit the nearest healthcare centres if any of the symptoms or conditions are visible in a person.