Pinta

Dermatology

Clinicals - History

Fact Explanation
Skin lesion Pinta is a chronic dermatological disease endemic to Central and South American region. It is caused by a spirochete called Treponema pallidum carateum. It is thought to spread by direct contact. Theadults. disease is more common among young adults.
Patients may encounter small raised bumps (Papules) which enlarge slowly at initial stage. Exposed areas of dorsum of the foot, the legs, hands or forearms are commonly affected. The raised bump becomes itchy, red and scaly and eventually a pigmented firmer (hyperkeratotic) and flat lesion (Plaque). Usually after 3-6 months (or up to 3 years) from the initial presentation further thickened and flat lesions (pintids) appear all over the body. They show abnormal pigmentation and scaling. Lesions may appear red, white, blue, violet, or brown.Initial papules and pintids may resolve with time in a majority of patients. But some patients develop late-stage disease, characterised by widespread mixture of hyperpigmentation and depigmentation. These lesions may appear red, white, blue, violet, and brown and often disfiguring. The affected skin become atrophic and thin.
Skin lesion
Pinta is a chronic dermatological disease endemic to Central and South American region. It is caused by a spirochete called Treponema pallidum carateum. It is thought to spread by direct contact. Theadults. disease is more common among young adults.
Patients may encounter small raised bumps (Papules) which enlarge slowly at initial stage. Exposed areas of dorsum of the foot, the legs, hands or forearms are commonly affected. The raised bump becomes itchy, red and scaly and eventually a pigmented firmer (hyperkeratotic) and flat lesion (Plaque). Usually after 3-6 months (or up to 3 years) from the initial presentation further thickened and flat lesions (pintids) appear all over the body. They show abnormal pigmentation and scaling. Lesions may appear red, white, blue, violet, or brown.Initial papules and pintids may resolve with time in a majority of patients. But some patients develop late-stage disease, characterised by widespread mixture of hyperpigmentation and depigmentation. These lesions may appear red, white, blue, violet, and brown and often disfiguring. The affected skin become atrophic and thin.

Clinicals - Examination

Fact Explanation
Primary pinta (Papules and plaques) This is composed of several papules to hyperkeraotic, pigmented plaque in exposed areas such as legs, dorsum of foot, forearm and hands. Primary pinta (Papules and plaques)
This is composed of several papules to hyperkeraotic, pigmented plaque in exposed areas such as legs, dorsum of foot, forearm and hands.
Secondary pinta (Pintids) Abnormally pigmented, thickened plaques with red, white, blue, violet, or brown colors may appear all over the body including unexposed areas. Secondary pinta (Pintids)
Abnormally pigmented, thickened plaques with red, white, blue, violet, or brown colors may appear all over the body including unexposed areas.
Tertiary pinta This is characterized by disfiguring hypo/hyperpigmentations all over the body. Tertiary pinta
This is characterized by disfiguring hypo/hyperpigmentations all over the body.
Lymphadenopathy Regional lymph node enlargement may occur from the primary stage. Lymphadenopathy
Regional lymph node enlargement may occur from the primary stage.

Investigations - Diagnosis

Fact Explanation
Dark field microscopy Treponemes can be demonstrated from swabs taken from early papules. Dark field microscopy
Treponemes can be demonstrated from swabs taken from early papules.
Treponema pallidum particle agglutination assay (TPPA) TPPA is a confirmatory treponemal test and an indirect agglutination assay used for detection and titration of antibodies against Treponema pallidum. This is also positive in pinta. Treponema pallidum particle agglutination assay (TPPA)
TPPA is a confirmatory treponemal test and an indirect agglutination assay used for detection and titration of antibodies against Treponema pallidum. This is also positive in pinta.
Venereal Disease Research Laboratory (VDRL) test This is a widely used as a nontreponemal serological screening for syphilis. But this is positive in pinta. Venereal Disease Research Laboratory (VDRL) test
This is a widely used as a nontreponemal serological screening for syphilis. But this is positive in pinta.
Rapid plasma reagent (RPR) It is a rapid diagnostic test that looks for non-specific antibodies for Treponema pallidum species. RPR is always positive in pinta from the initial stage. Rapid plasma reagent (RPR)
It is a rapid diagnostic test that looks for non-specific antibodies for Treponema pallidum species. RPR is always positive in pinta from the initial stage.
Histology Biopsy of the lesions may reveal characteristic microscopic changes such as mild acanthosis, migration of lymphoid cells into the epidermis and epidermal atrophy eventually. In early lesions, treponemes may be demonstrated using silver stain. Histology
Biopsy of the lesions may reveal characteristic microscopic changes such as mild acanthosis, migration of lymphoid cells into the epidermis and epidermal atrophy eventually. In early lesions, treponemes may be demonstrated using silver stain.

Management - Specific

Fact Explanation
Antibiotics Benzathine penicillin is the drug of choice However this should not be given to patients those who are allergic to penicillin. Tetracycline or erythromycin are the alternative therapies for such patients. Skin lesions become non-infectious within 24 hours of treatment. Early lesions heal within 6 to 12 months, but pigmentary changes persist in late lesions. Antibiotics
Benzathine penicillin is the drug of choice However this should not be given to patients those who are allergic to penicillin. Tetracycline or erythromycin are the alternative therapies for such patients. Skin lesions become non-infectious within 24 hours of treatment. Early lesions heal within 6 to 12 months, but pigmentary changes persist in late lesions.

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