Pinta

Infectious Disease MONDO:0000979 Pathograph 11 Show in embeddings browser Bacterial Infection Neglected tropical disease

Pinta is a chronic, non-venereal treponematosis caused by Treponema carateum and transmitted by direct skin-to-skin contact in warm, humid rural areas of Latin America. Alone among the four human treponematoses it is confined to the skin: it produces no bone, cartilage, cardiovascular or neurological disease. Infection begins as an itchy, scaly papule or plaque at the inoculation site, disseminates within the skin as long-lived secondary lesions ("pintids"), and ends in the dyschromic and achromic patches that give the disease its name. A single intramuscular injection of penicillin cures every stage, but the late pigmentary change is largely irreversible, so the disability pinta leaves behind is cosmetic and social rather than systemic. Two features make pinta the outlier of its group. Its agent is the only one of the four not classified as a Treponema pallidum subspecies - not because it is known to be more distant, but because T. carateum has never been cultivated or sequenced, so the genomic comparison that settled the other three has never been possible. And because the treponemes are serologically indistinguishable, a pinta diagnosis rests on lesion morphology plus residence in a historically endemic area; the serology alone cannot separate it from syphilis.

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5
Pathophys.
3
Histopath.
12
Phenotypes
11
Pathograph
1
Medical Actions
4
Differentials
2
References
1
Deep Research
⚙

Pathophysiology

5
Cutaneous Treponemal Inoculation
Direct contact with an infectious lesion introduces Treponema carateum into the skin, where it replicates locally and produces the primary scaly papule or plaque. The inoculation site is typically an exposed extremity.
symbiont entry into host GO:0044409 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves symbiont entry into host (GO:0044409). GO:0044409 is a biological process from the Gene Ontology.
skin UBERON:0002097 Uberon multi-species anatomy ontology (UBERON) Relation: this pathophysiological event occurs in this anatomical location This pathophysiological event occurs in skin, annotated with skin of body (UBERON:0002097). UBERON:0002097 is an anatomical location from the Uberon multi-species anatomy ontology.
Downstream
Intradermal Treponemal Dissemination Untreated primary infection spreads within the skin to produce secondary lesions.
Skin plaque Local replication produces an expanding scaly plaque at the inoculation site.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"Yaws and pinta are found in warm, moist climates, mainly in forested tropical regions, and are transmitted by direct skin-to-skin contact."
Establishes skin contact as the route by which the organism reaches the inoculation site.
Intradermal Treponemal Dissemination
The organism spreads within the skin to produce disseminated secondary lesions that remain viable and transmissible for years. Dissemination is confined to the dermis and epidermis: pinta produces none of the bone, cartilage, cardiovascular or neurological involvement seen in the other treponematoses, and this skin-limited tropism is the single feature that most distinguishes it from yaws, bejel and syphilis.
skin UBERON:0002097 Uberon multi-species anatomy ontology (UBERON) Relation: this pathophysiological event occurs in this anatomical location This pathophysiological event occurs in skin, annotated with skin of body (UBERON:0002097). UBERON:0002097 is an anatomical location from the Uberon multi-species anatomy ontology.
Downstream
Melanocyte Injury and Basal Melanin Loss Persistent intradermal infection drives the pigmentary lesion of pinta.
Skin rash Dissemination within the skin produces the generalized secondary eruption.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"pinta is a noninvasive condition causing only local dermal lesions."
Supports the skin-limited tropism this node asserts, in contrast with the moderately invasive course of yaws and bejel.
Melanocyte Injury and Basal Melanin Loss
In early lesions the basal layer loses melanin and undergoes liquefaction degeneration, the cellular event that converts a treponemal skin infection into a pigmentary disease. This is what makes pinta unique among the treponematoses: the organism's lasting damage is to the pigmentary apparatus of the epidermis rather than to tissue architecture.
melanocyte CL:0000148 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves melanocyte (CL:0000148). CL:0000148 is a cell type from the Cell Ontology.
melanin biosynthetic process GO:0042438 ↓ DECREASED Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves decreased melanin biosynthetic process (GO:0042438). GO:0042438 is a biological process from the Gene Ontology.
Downstream
Hypopigmentation of the skin Loss of basal-layer melanin produces the hypochromic and achromic lesions.
Dermal Melanophage Accumulation and Epidermal Atrophy Melanin released from injured basal cells is taken up by dermal macrophages.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"In the early lesion, there is loss of melanin in basal cells and liquefaction degeneration."
The histological description of the early lesion, which is the direct evidence for melanocyte-level injury.
Dermal Melanophage Accumulation and Epidermal Atrophy
Late lesions show epidermal atrophy and numerous melanin-laden macrophages in the dermis. Because the pigment has been relocated from the epidermis into dermal melanophages rather than merely lost, the dyschromia is structural, which is why depigmentation persists after the infection is cured and treatment restores infectivity status but not appearance.
melanophage CL:0000235 Cell Ontology (CL) Relation: this pathophysiological event involves this cell type This pathophysiological event involves melanophage, annotated with macrophage (CL:0000235). CL:0000235 is a cell type from the Cell Ontology.
skin UBERON:0002097 Uberon multi-species anatomy ontology (UBERON) Relation: this pathophysiological event occurs in this anatomical location This pathophysiological event occurs in skin, annotated with skin of body (UBERON:0002097). UBERON:0002097 is an anatomical location from the Uberon multi-species anatomy ontology.
Downstream
Diffuse skin atrophy Late lesions thin the epidermis.
Hypopigmented skin patches Pigment relocation into the dermis leaves persistent achromic patches.
Show evidence (2 references)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"Epidermal atrophy and the presence of many melanophages in the dermis are typical findings of late-stage pinta"
The histological definition of the late-stage lesion this node represents.
PMID:26304920 SUPPORT Other
"Although early pinta lesions heal within several months after penicillin administration, this treatment cannot reverse the skin changes of late pinta that can stigmatize those who were infected."
Supports this node's central claim that the late pigmentary lesion is structural rather than active infection: curing the organism does not undo it.
Treponemal Peptidoglycan Cross-Linking (Beta-Lactam Target)
Treponema carateum maintains its peptidoglycan cell wall by penicillin-binding protein (PBP) transpeptidase cross-linking. This essential, bacteria-specific reaction is the target of the penicillin used to treat pinta: beta-lactam acylation of the PBP active site halts cross-linking and is treponemicidal, which is why a single penicillin injection cures all stages.
Peptidoglycan-Based Cell Wall Biogenesis GO:0009273 Gene Ontology (GO) Relation: this pathophysiological event involves this biological process This pathophysiological event involves Peptidoglycan-Based Cell Wall Biogenesis (GO:0009273). GO:0009273 is a biological process from the Gene Ontology.
Show evidence (1 reference)
PMID:22203377 SUPPORT Other
"although glycan chain polymerization occurs in the absence of transpeptidation (for example, in the presence of penicillin), efficient transpeptidation requires ongoing GTase reactions"
Establishes that beta-lactams (penicillin) act by blocking PBP transpeptidation, the cross-linking step this node represents. Evidence source is OTHER as this is a review article.
✶

Histopathology

3
Basal-cell melanin loss with liquefaction degeneration
The early lesion shows loss of melanin from basal keratinocytes together with liquefaction degeneration of the basal layer.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"In the early lesion, there is loss of melanin in basal cells and liquefaction degeneration."
The histological description of the early pinta lesion.
Epidermal atrophy with dermal melanophages
The late lesion shows a thinned epidermis and abundant melanin-laden macrophages in the dermis.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"Epidermal atrophy and the presence of many melanophages in the dermis are typical findings of late-stage pinta"
The histological description of the late pinta lesion.
Absence of ulceration
Unlike yaws, pinta lesions do not ulcerate. This is a negative finding that distinguishes the two on biopsy as well as clinically.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"In pinta, there is no ulcer formation comparable to that in yaws"
States the absence of ulceration that separates pinta from yaws histologically.
⬡

Pathograph

Use the checkboxes to hide or show graph categories. Hover nodes for evidence and cross-linked metadata.
Pathograph: causal mechanism network for Pinta Interactive directed graph showing how pathophysiology mechanisms, phenotypes, genetic factors and variants, experimental models, environmental triggers, and treatments relate through causal and linked edges.
●

Phenotypes

12
Cardiovascular 1
Lymphadenopathy HP:0002716 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Regional lymphadenopathy, annotated with Lymphadenopathy (HP:0002716). HP:0002716 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:26304920 SUPPORT Other
"expands to a diameter of 10 cm or greater. Regional lymphadenopathy is common."
Reports regional lymphadenopathy in the primary stage. Bound to the general HP term because HP carries no regional-lymphadenopathy class, so the regional qualifier is held in preferred_term.
Immune 1
Skin rash HP:0000988 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Skin rash (HP:0000988). HP:0000988 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"In pinta, lesions remain active and infectious for many years"
Supports a persistent disseminated cutaneous eruption.
Integument 10
Papule HP:0200034 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Papule (HP:0200034). HP:0200034 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"the pinta primary lesion is an itchy, scaly papule or plaque that expands to greater than 10 cm but does not ulcerate"
Names the papular form of the primary lesion.
Skin plaque HP:0200035 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Skin plaque (HP:0200035). HP:0200035 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"the pinta primary lesion is an itchy, scaly papule or plaque that expands to greater than 10 cm but does not ulcerate"
Names the plaque form and its size, and records the absence of ulceration.
Scaling skin HP:0040189 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Scaling skin (HP:0040189). HP:0040189 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"the pinta primary lesion is an itchy, scaly papule or plaque that expands to greater than 10 cm but does not ulcerate"
Records the scaly character of the primary lesion.
Pruritus HP:0000989 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Pruritus (HP:0000989). HP:0000989 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"the pinta primary lesion is an itchy, scaly papule or plaque that expands to greater than 10 cm but does not ulcerate"
Records pruritus as a feature of the primary lesion.
Hypopigmentation of the skin FREQUENT HP:0001010 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Hypopigmentation of the skin (HP:0001010). HP:0001010 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"leading to extensive depigmentation and acral dyschromia"
Directly reports extensive depigmentation in pinta.
Hyperpigmentation of the skin HP:0000953 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Hyperpigmentation of the skin (HP:0000953). HP:0000953 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"leading to extensive depigmentation and acral dyschromia"
Supports mixed pigmentary change. The source says dyschromia rather than hyperpigmentation specifically, so this binding is the narrower reading of a broader term and should not be read as a separately reported finding.
Hypopigmented skin patches HP:0001053 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Hypopigmented skin patches (HP:0001053). HP:0001053 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"leading to extensive depigmentation and acral dyschromia"
Supports patchy depigmentation as the late cutaneous outcome.
Diffuse skin atrophy HP:0007488 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Diffuse skin atrophy (HP:0007488). HP:0007488 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"Epidermal atrophy and the presence of many melanophages in the dermis are typical findings of late-stage pinta"
Reports epidermal atrophy as a typical late-stage finding.
Hyperkeratosis HP:0000962 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Hyperkeratosis (HP:0000962). HP:0000962 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:26304920 SUPPORT Other
"The late (tertiary) stage usually develops 2–5 years after initial infection and is characterized by pigmentary abnormalities (i.e., from dyschromic treponeme-containing lesions to achromic treponeme-free lesions), skin atrophy, and hyperkeratosis."
Names hyperkeratosis directly as a feature of the late stage.
Abnormality of skin pigmentation FREQUENT HP:0001000 Human Phenotype Ontology (HP) Relation: this clinical feature is this phenotype This clinical feature is Abnormality of skin pigmentation (HP:0001000). HP:0001000 is a phenotype from the Human Phenotype Ontology.
Show evidence (1 reference)
PMID:23332859 SUPPORT Other
"Mal del pinto is a dermatological disease characterized by discoloured patches of skin on the face and body."
The abstract describes discoloured patches of skin in pinta.
💊

Medical Actions

1
Penicillin injection
Action: PharmacotherapyNCI Thesaurus (NCIT) Relation: this treatment is this clinical intervention This treatment is Pharmacotherapy (NCIT:C15986). NCIT:C15986 is a clinical intervention from the NCI Thesaurus. NCIT:C15986
Agent: benzylpenicillin CHEBI:18208 Chemical Entities of Biological Interest (CHEBI) Relation: this treatment uses this therapeutic agent This treatment uses benzylpenicillin (CHEBI:18208). CHEBI:18208 is a therapeutic agent from Chemical Entities of Biological Interest.
Platform: Small molecule
A single intramuscular injection of long-acting benzathine penicillin cures every stage of pinta and renders the lesions non-infectious within a day. It does not restore the pigment lost in late disease, so treatment ends transmission and halts progression without undoing the disfigurement that is the disease's lasting burden.
Mechanism Target:
Treponemal Peptidoglycan Cross-Linking (Beta-Lactam Target) — Penicillin acylates the treponemal PBP transpeptidase, blocking peptidoglycan cross-linking and killing the organism.
Show evidence (3 references)
PMID:26304920 SUPPORT Other
"All stages of pinta are treatable with a single intramuscular injection of penicillin."
The abstract states that penicillin injection treats pinta.
PMID:26304920 SUPPORT Other
"which renders the lesions noninfectious in less than 24 hours"
Quantifies how quickly treatment ends infectiousness.
PMID:26304920 SUPPORT Other
"Although early pinta lesions heal within several months after penicillin administration, this treatment cannot reverse the skin changes of late pinta that can stigmatize those who were infected."
Establishes the limit of cure - early lesions heal, late pigmentary change does not - which is why this entry treats the residual disfigurement as an outcome rather than as treatment failure.
🔬

Diagnosis

2
Clinical and epidemiologic diagnosis
Diagnosis rests on compatible lesion morphology together with residence in, or origin from, a historically endemic area, plus exclusion of the dyspigmentation mimics. Serology confirms treponemal infection but cannot name which treponematosis it is.
Show evidence (1 reference)
PMID:26304920 SUPPORT Other
"U.S. physicians should consider pinta in the differential diagnosis of skin diseases in children and adolescents who come from areas where pinta was previously endemic and have a positive reaction in serological tests for syphilis."
Describes the actual diagnostic pathway - endemic-area origin plus reactive syphilis serology plus compatible skin disease.
Treponemal and nontreponemal serology
The same tests used for syphilis (RPR or VDRL, confirmed by TPHA, TPPA or FTA-Abs) are used for pinta. Their central limitation is that they are positive in every treponematosis, so a reactive result establishes treponemal infection but not which one.
Show evidence (2 references)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"treponemal tests TPHA, TPPA, and FTA-Abs are more specific, but remain positive for life"
Names the confirmatory treponemal tests used across the endemic treponematoses.
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"serological tests cannot distinguish between endemic treponematoses infections and syphilis"
States the limitation that makes serology non-diagnostic for pinta specifically and forces reliance on clinical and epidemiologic context.
🪜

Stages

3
Primary pinta
An itchy, scaly papule or plaque appears at the inoculation site, usually on an exposed extremity, and enlarges to more than 10 cm. Unlike the primary lesion of yaws it does not ulcerate.
Show evidence (2 references)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"the pinta primary lesion is an itchy, scaly papule or plaque that expands to greater than 10 cm but does not ulcerate"
Defines the primary lesion and its distinguishing absence of ulceration.
PMID:26304920 SUPPORT Other
"The primary stage is characterized by the presence of one or several papules or erythematous scaly plaques that develop about 3 weeks after infection."
Gives the incubation interval and the papular or plaque form of the primary lesion.
Secondary pinta
Disseminated skin lesions (pintids) appear months after the primary lesion and remain active and infectious for years, developing progressive pigmentary change. Dissemination stays within the skin.
Show evidence (3 references)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"In pinta, lesions remain active and infectious for many years"
Supports the defining feature of the secondary stage - lesions that persist and stay transmissible rather than resolving as secondary yaws lesions do.
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"pinta is a noninvasive condition causing only local dermal lesions."
Supports that dissemination remains confined to the skin, in contrast to the bone and cartilage involvement of secondary yaws and bejel.
PMID:26304920 SUPPORT Other
"The secondary stage usually appears several months after the initial manifestations of the primary stage."
Gives the interval between the primary and secondary stages.
Late pinta
Years after infection the lesions become dyschromic and then achromic, accompanied by cutaneous atrophy. The depigmentation persists after cure.
Show evidence (3 references)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"Epidermal atrophy and the presence of many melanophages in the dermis are typical findings of late-stage pinta"
Defines the histological signature of the late stage.
PMID:26304920 SUPPORT Other
"The late (tertiary) stage usually develops 2–5 years after initial infection and is characterized by pigmentary abnormalities"
Gives the interval to late disease and names its defining pigmentary character.
PMID:26304920 SUPPORT Other
"resulting in a mottled appearance of the skin, which can persist lifelong"
Supports the lifelong persistence of the pigmentary change, which is the basis for treating pinta's disability as cosmetic and permanent rather than as active infection.
📊

Prevalence

2
Rural Panama, 1980s survey
Point Prevalence 20000.0 per 100,000 >1 in 1,000
20% of the surveyed population with active or inactive disease. A local survey in a historically hyperendemic setting, not a national figure, and four decades old - it bounds how intense transmission once was rather than describing current burden.
Show evidence (2 references)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"A survey in Panama in the 1980s noted evidence of active or inactive pinta among 20% of the population"
Reports the surveyed prevalence figure and that it counts both active and inactive disease.
PMID:26304920 SUPPORT Other
"clinical evidence of pinta was discovered in 20% of the examined inhabitants of a remote village in Panama"
Independently reports the same survey and locates it precisely to a single remote village, which is why this figure is recorded as a local rather than a national rate.
Latin America, current
Point Prevalence Not yet documented
No current figure exists. Pinta has no active surveillance programme, and unlike yaws it is not covered by a WHO eradication campaign that would generate case counts.
Show evidence (1 reference)
PMID:26304920 SUPPORT Other
"the current prevalence of pinta is unknown due to the lack of surveillance data"
States directly that no current prevalence estimate is available.
🌍

Epidemiology

1
Formerly endemic across tropical Latin America
Pinta was endemic across Mexico, Central America and northern South America, and persisted longest in remote forested communities. It is now rare, with residual foci reported in remote regions of Mexico and among Amazonian communities in Brazil, Colombia and Peru.
rural and remote residence warm humid tropical climate poverty and limited health-system access
Show evidence (2 references)
PMID:26304920 SUPPORT Other
"The World Health Organization lists 15 countries in Latin America where pinta was previously endemic."
Establishes the historical geographic extent.
DOI:10.15585/mmwr.rr7301a1 SUPPORT Other
"Treponema carateum infection results in pinta which, although rare, is found in tropical areas of Latin America"
Confirms current rarity and the continuing Latin American distribution.
🦠

Infectious Agent

1
Treponema carateum
A non-cultivable spirochete, morphologically and serologically identical to the three Treponema pallidum subspecies that cause syphilis, yaws and bejel. It is the only agent of the four still carried as a separate species, because the absence of isolates has prevented the whole-genome comparison used to assign the others to subspecies rank.
Treponema carateum NCBITaxon:3712027 NCBI Taxonomy (NCBITaxon)
Show evidence (3 references)
PMID:24396138 SUPPORT Other
"T. pallidum subsp. pertenue, T. pallidum subsp. endemicum, and T. carateum are the agents of the endemic treponematoses yaws, bejel (or endemic syphilis), and pinta, respectively."
The abstract identifies T. carateum as the agent of pinta.
PMID:26304920 SUPPORT Other
"The etiological agent of pinta, Treponema carateum, cannot be distinguished morphologically or serologically from the not-yet-cultivable Treponema pallidum subspecies that cause venereal syphilis, yaws, and bejel."
Supports both the identity of the agent and the morphologic and serologic indistinguishability that makes pinta a diagnosis of clinical and epidemiologic context rather than of laboratory confirmation.
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"is not currently classified as a T. pallidum subspecies since our molecular knowledge at this time is insufficient to warrant such a classification"
States why T. carateum retains separate species rank. The claim is about absent evidence, not demonstrated distance, which is why this entry does not assert a subspecies relationship in either direction.
↔️

Transmission

1
Direct skin-to-skin contact
Non-venereal transmission by direct contact with an infectious skin lesion, favoured by the warm, humid conditions that keep lesions moist and infectious. There is no sexual, congenital or vector-borne route.
Show evidence (2 references)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"Yaws and pinta are found in warm, moist climates, mainly in forested tropical regions, and are transmitted by direct skin-to-skin contact."
Directly states the transmission route and the climatic setting that supports it.
PMID:26304920 SUPPORT Other
"the endemic treponematoses are transmitted by nonsexual, direct skin-to-skin contact with infectious lesions"
States the route explicitly as non-sexual, which is the contrast with syphilis that this entry's transmission section turns on.
🔀

Differential Diagnoses

4

Conditions with similar clinical presentations that must be differentiated from Pinta:

Tinea versicolor
Overlapping Features A common tropical dyspigmentation that mimics the dyschromic lesions of pinta.
Distinguishing Features
  • Superficial scale demonstrating hyphae and spores on potassium hydroxide microscopy
  • Non-reactive treponemal serology
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"Disorders associated with dyspigmentation, such as tinea versicolor, vitiligo, melasma, and leprosy, are often in the differential diagnosis of pinta"
Names tinea versicolor as a differential for pinta.
Vitiligo
Overlapping Features Acquired depigmented macules that closely resemble the achromic patches of late pinta.
Distinguishing Features
  • No preceding papular or plaque stage
  • No endemic exposure history
  • Non-reactive treponemal serology
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"Disorders associated with dyspigmentation, such as tinea versicolor, vitiligo, melasma, and leprosy, are often in the differential diagnosis of pinta"
Names vitiligo as a differential for pinta.
Melasma
Overlapping Features Acquired hyperpigmentation that overlaps with the dyschromic phase of pinta.
Distinguishing Features
  • Symmetric facial distribution
  • Association with pregnancy or sun exposure
  • Non-reactive treponemal serology
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"Disorders associated with dyspigmentation, such as tinea versicolor, vitiligo, melasma, and leprosy, are often in the differential diagnosis of pinta"
Names melasma as a differential for pinta.
Leprosy
Overlapping Features Hypopigmented patches of tuberculoid leprosy are the most consequential mimic, since the two share endemic settings and both are treatable infections.
Distinguishing Features
  • Sensory loss within the hypopigmented patch, which does not occur in pinta
  • Peripheral nerve thickening
  • Acid-fast bacilli on slit-skin smear
Show evidence (1 reference)
DOI:10.1371/journal.pntd.0002283 SUPPORT Other
"Disorders associated with dyspigmentation, such as tinea versicolor, vitiligo, melasma, and leprosy, are often in the differential diagnosis of pinta"
Names leprosy as a differential for pinta.
{ }

Source YAML

click to show 
name: Pinta
creation_date: '2026-01-26T15:40:02Z'
category: Infectious Disease
description: >-
  Pinta is a chronic, non-venereal treponematosis caused by Treponema carateum
  and transmitted by direct skin-to-skin contact in warm, humid rural areas of
  Latin America. Alone among the four human treponematoses it is confined to
  the skin: it produces no bone, cartilage, cardiovascular or neurological
  disease. Infection begins as an itchy, scaly papule or plaque at the
  inoculation site, disseminates within the skin as long-lived secondary
  lesions ("pintids"), and ends in the dyschromic and achromic patches that
  give the disease its name. A single intramuscular injection of penicillin
  cures every stage, but the late pigmentary change is largely irreversible,
  so the disability pinta leaves behind is cosmetic and social rather than
  systemic.

  Two features make pinta the outlier of its group. Its agent is the only one
  of the four not classified as a Treponema pallidum subspecies - not because
  it is known to be more distant, but because T. carateum has never been
  cultivated or sequenced, so the genomic comparison that settled the other
  three has never been possible. And because the treponemes are serologically
  indistinguishable, a pinta diagnosis rests on lesion morphology plus
  residence in a historically endemic area; the serology alone cannot separate
  it from syphilis.
synonyms:
- mal del pinto
- carate
- mal de pinta
disease_term:
  term:
    id: MONDO:0000979
    label: pinta disease
  preferred_term: Pinta
parents:
- Bacterial Infection
- Neglected tropical disease
infectious_agent:
- name: Treponema carateum
  description: >-
    A non-cultivable spirochete, morphologically and serologically identical to
    the three Treponema pallidum subspecies that cause syphilis, yaws and
    bejel. It is the only agent of the four still carried as a separate
    species, because the absence of isolates has prevented the whole-genome
    comparison used to assign the others to subspecies rank.
  infectious_agent_term:
    preferred_term: Treponema carateum
    term:
      id: NCBITaxon:3712027
      label: Treponema carateum
  evidence:
  - reference: PMID:24396138
    reference_title: "The endemic treponematoses."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "T. pallidum subsp. pertenue, T. pallidum subsp. endemicum, and T. carateum are the agents of the endemic treponematoses yaws, bejel (or endemic syphilis), and pinta, respectively."
    explanation: The abstract identifies T. carateum as the agent of pinta.
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      The etiological agent of pinta, Treponema carateum, cannot be
      distinguished morphologically or serologically from the not-yet-cultivable
      Treponema pallidum subspecies that cause venereal syphilis, yaws, and
      bejel.
    explanation: >-
      Supports both the identity of the agent and the morphologic and
      serologic indistinguishability that makes pinta a diagnosis of clinical
      and epidemiologic context rather than of laboratory confirmation.
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      is not currently classified as a T. pallidum subspecies since our
      molecular knowledge at this time is insufficient to warrant such a
      classification
    explanation: >-
      States why T. carateum retains separate species rank. The claim is about
      absent evidence, not demonstrated distance, which is why this entry does
      not assert a subspecies relationship in either direction.
transmission:
- name: Direct skin-to-skin contact
  description: >-
    Non-venereal transmission by direct contact with an infectious skin lesion,
    favoured by the warm, humid conditions that keep lesions moist and
    infectious. There is no sexual, congenital or vector-borne route.
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Yaws and pinta are found in warm, moist climates, mainly in forested
      tropical regions, and are transmitted by direct skin-to-skin contact.
    explanation: Directly states the transmission route and the climatic setting that supports it.
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      the endemic treponematoses are transmitted by nonsexual, direct
      skin-to-skin contact with infectious lesions
    explanation: >-
      States the route explicitly as non-sexual, which is the contrast with
      syphilis that this entry's transmission section turns on.
prevalence:
- population: Rural Panama, 1980s survey
  measure_type: POINT_PREVALENCE
  prevalence_class: ABOVE_1_IN_1000
  rate_per_100000: 20000.0
  notes: >-
    20% of the surveyed population with active or inactive disease. A local
    survey in a historically hyperendemic setting, not a national figure, and
    four decades old - it bounds how intense transmission once was rather than
    describing current burden.
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      A survey in Panama in the 1980s noted evidence of active or inactive
      pinta among 20% of the population
    explanation: Reports the surveyed prevalence figure and that it counts both active and inactive disease.
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      clinical evidence of pinta was discovered in 20% of the examined
      inhabitants of a remote village in Panama
    explanation: >-
      Independently reports the same survey and locates it precisely to a
      single remote village, which is why this figure is recorded as a local
      rather than a national rate.
- population: Latin America, current
  measure_type: POINT_PREVALENCE
  prevalence_class: NOT_YET_DOCUMENTED
  notes: >-
    No current figure exists. Pinta has no active surveillance programme, and
    unlike yaws it is not covered by a WHO eradication campaign that would
    generate case counts.
  evidence:
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "the current prevalence of pinta is unknown due to the lack of surveillance data"
    explanation: States directly that no current prevalence estimate is available.
epidemiology:
- name: Formerly endemic across tropical Latin America
  description: >-
    Pinta was endemic across Mexico, Central America and northern South
    America, and persisted longest in remote forested communities. It is now
    rare, with residual foci reported in remote regions of Mexico and among
    Amazonian communities in Brazil, Colombia and Peru.
  factors:
  - rural and remote residence
  - warm humid tropical climate
  - poverty and limited health-system access
  evidence:
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "The World Health Organization lists 15 countries in Latin America where pinta was previously endemic."
    explanation: Establishes the historical geographic extent.
  - reference: DOI:10.15585/mmwr.rr7301a1
    reference_title: "CDC Laboratory Recommendations for Syphilis Testing, United States, 2024"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Treponema carateum infection results in pinta which, although rare, is
      found in tropical areas of Latin America
    explanation: Confirms current rarity and the continuing Latin American distribution.
stages:
- name: Primary pinta
  description: >-
    An itchy, scaly papule or plaque appears at the inoculation site, usually
    on an exposed extremity, and enlarges to more than 10 cm. Unlike the
    primary lesion of yaws it does not ulcerate.
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      the pinta primary lesion is an itchy, scaly papule or plaque that expands
      to greater than 10 cm but does not ulcerate
    explanation: Defines the primary lesion and its distinguishing absence of ulceration.
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      The primary stage is characterized by the presence of one or several
      papules or erythematous scaly plaques that develop about 3 weeks after
      infection.
    explanation: Gives the incubation interval and the papular or plaque form of the primary lesion.
- name: Secondary pinta
  description: >-
    Disseminated skin lesions (pintids) appear months after the primary lesion
    and remain active and infectious for years, developing progressive
    pigmentary change. Dissemination stays within the skin.
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      In pinta, lesions remain active and infectious for many years
    explanation: >-
      Supports the defining feature of the secondary stage - lesions that
      persist and stay transmissible rather than resolving as secondary yaws
      lesions do.
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "pinta is a noninvasive condition causing only local dermal lesions."
    explanation: >-
      Supports that dissemination remains confined to the skin, in contrast to
      the bone and cartilage involvement of secondary yaws and bejel.
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      The secondary stage usually appears several months after the initial
      manifestations of the primary stage.
    explanation: Gives the interval between the primary and secondary stages.
- name: Late pinta
  description: >-
    Years after infection the lesions become dyschromic and then achromic,
    accompanied by cutaneous atrophy. The depigmentation persists after cure.
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Epidermal atrophy and the presence of many melanophages in the dermis are
      typical findings of late-stage pinta
    explanation: Defines the histological signature of the late stage.
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      The late (tertiary) stage usually develops 2–5 years after initial
      infection and is characterized by pigmentary abnormalities
    explanation: Gives the interval to late disease and names its defining pigmentary character.
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      resulting in a mottled appearance of the skin, which can persist
      lifelong
    explanation: >-
      Supports the lifelong persistence of the pigmentary change, which is the
      basis for treating pinta's disability as cosmetic and permanent rather
      than as active infection.
pathophysiology:
- name: Cutaneous Treponemal Inoculation
  biological_scale: TISSUE
  description: >-
    Direct contact with an infectious lesion introduces Treponema carateum into
    the skin, where it replicates locally and produces the primary scaly papule
    or plaque. The inoculation site is typically an exposed extremity.
  biological_processes:
  - preferred_term: symbiont entry into host
    term:
      id: GO:0044409
      label: symbiont entry into host
  locations:
  - preferred_term: skin
    term:
      id: UBERON:0002097
      label: skin of body
  downstream:
  - target: Intradermal Treponemal Dissemination
    description: Untreated primary infection spreads within the skin to produce secondary lesions.
    evidence:
    - reference: DOI:10.1371/journal.pntd.0002283
      reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
      supports: SUPPORT
      evidence_source: OTHER
      snippet: >-
        In pinta, lesions remain active and infectious for many years
      explanation: Supports progression from the primary lesion to persistent disseminated disease.
  - target: Skin plaque
    description: Local replication produces an expanding scaly plaque at the inoculation site.
    evidence:
    - reference: DOI:10.1371/journal.pntd.0002283
      reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
      supports: SUPPORT
      evidence_source: OTHER
      snippet: >-
        the pinta primary lesion is an itchy, scaly papule or plaque that expands
        to greater than 10 cm but does not ulcerate
      explanation: Links the inoculation mechanism to its primary cutaneous lesion.
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Yaws and pinta are found in warm, moist climates, mainly in forested
      tropical regions, and are transmitted by direct skin-to-skin contact.
    explanation: Establishes skin contact as the route by which the organism reaches the inoculation site.
- name: Intradermal Treponemal Dissemination
  biological_scale: TISSUE
  description: >-
    The organism spreads within the skin to produce disseminated secondary
    lesions that remain viable and transmissible for years. Dissemination is
    confined to the dermis and epidermis: pinta produces none of the bone,
    cartilage, cardiovascular or neurological involvement seen in the other
    treponematoses, and this skin-limited tropism is the single feature that
    most distinguishes it from yaws, bejel and syphilis.
  locations:
  - preferred_term: skin
    term:
      id: UBERON:0002097
      label: skin of body
  downstream:
  - target: Melanocyte Injury and Basal Melanin Loss
    description: Persistent intradermal infection drives the pigmentary lesion of pinta.
    evidence:
    - reference: DOI:10.1371/journal.pntd.0002283
      reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
      supports: SUPPORT
      evidence_source: OTHER
      snippet: "In the early lesion, there is loss of melanin in basal cells and liquefaction degeneration."
      explanation: Identifies basal-cell melanin loss as the earliest pigmentary consequence of skin infection.
  - target: Skin rash
    description: Dissemination within the skin produces the generalized secondary eruption.
    evidence:
    - reference: DOI:10.1371/journal.pntd.0002283
      reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
      supports: SUPPORT
      evidence_source: OTHER
      snippet: >-
        In pinta, lesions remain active and infectious for many years
      explanation: Links dissemination to the persistent secondary lesions.
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "pinta is a noninvasive condition causing only local dermal lesions."
    explanation: >-
      Supports the skin-limited tropism this node asserts, in contrast with the
      moderately invasive course of yaws and bejel.
- name: Melanocyte Injury and Basal Melanin Loss
  biological_scale: CELLULAR
  description: >-
    In early lesions the basal layer loses melanin and undergoes liquefaction
    degeneration, the cellular event that converts a treponemal skin infection
    into a pigmentary disease. This is what makes pinta unique among the
    treponematoses: the organism's lasting damage is to the pigmentary
    apparatus of the epidermis rather than to tissue architecture.
  cell_types:
  - preferred_term: melanocyte
    term:
      id: CL:0000148
      label: melanocyte
  biological_processes:
  - preferred_term: melanin biosynthetic process
    modifier: DECREASED
    term:
      id: GO:0042438
      label: melanin biosynthetic process
  downstream:
  - target: Hypopigmentation of the skin
    description: Loss of basal-layer melanin produces the hypochromic and achromic lesions.
    evidence:
    - reference: DOI:10.1371/journal.pntd.0002283
      reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
      supports: SUPPORT
      evidence_source: OTHER
      snippet: "In the early lesion, there is loss of melanin in basal cells and liquefaction degeneration."
      explanation: Directly links basal melanin loss to the depigmented phenotype.
  - target: Dermal Melanophage Accumulation and Epidermal Atrophy
    description: Melanin released from injured basal cells is taken up by dermal macrophages.
    evidence:
    - reference: DOI:10.1371/journal.pntd.0002283
      reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
      supports: SUPPORT
      evidence_source: OTHER
      snippet: >-
        Epidermal atrophy and the presence of many melanophages in the dermis are
        typical findings of late-stage pinta
      explanation: Supports progression from early basal-layer injury to the late melanophage-rich lesion.
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "In the early lesion, there is loss of melanin in basal cells and liquefaction degeneration."
    explanation: >-
      The histological description of the early lesion, which is the direct
      evidence for melanocyte-level injury.
- name: Dermal Melanophage Accumulation and Epidermal Atrophy
  biological_scale: TISSUE
  description: >-
    Late lesions show epidermal atrophy and numerous melanin-laden macrophages
    in the dermis. Because the pigment has been relocated from the epidermis
    into dermal melanophages rather than merely lost, the dyschromia is
    structural, which is why depigmentation persists after the infection is
    cured and treatment restores infectivity status but not appearance.
  cell_types:
  - preferred_term: melanophage
    term:
      id: CL:0000235
      label: macrophage
  locations:
  - preferred_term: skin
    term:
      id: UBERON:0002097
      label: skin of body
  downstream:
  - target: Diffuse skin atrophy
    description: Late lesions thin the epidermis.
    evidence:
    - reference: DOI:10.1371/journal.pntd.0002283
      reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
      supports: SUPPORT
      evidence_source: OTHER
      snippet: >-
        Epidermal atrophy and the presence of many melanophages in the dermis are
        typical findings of late-stage pinta
      explanation: Directly links the late-stage lesion to cutaneous atrophy.
  - target: Hypopigmented skin patches
    description: Pigment relocation into the dermis leaves persistent achromic patches.
    evidence:
    - reference: DOI:10.1371/journal.pntd.0002283
      reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
      supports: SUPPORT
      evidence_source: OTHER
      snippet: "leading to extensive depigmentation and acral dyschromia"
      explanation: Supports the late achromic and dyschromic outcome of this node.
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Epidermal atrophy and the presence of many melanophages in the dermis are
      typical findings of late-stage pinta
    explanation: The histological definition of the late-stage lesion this node represents.
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Although early pinta lesions heal within several months after penicillin
      administration, this treatment cannot reverse the skin changes of late
      pinta that can stigmatize those who were infected.
    explanation: >-
      Supports this node's central claim that the late pigmentary lesion is
      structural rather than active infection: curing the organism does not
      undo it.
- name: Treponemal Peptidoglycan Cross-Linking (Beta-Lactam Target)
  description: >-
    Treponema carateum maintains its peptidoglycan cell wall by penicillin-binding
    protein (PBP) transpeptidase cross-linking. This essential, bacteria-specific
    reaction is the target of the penicillin used to treat pinta: beta-lactam
    acylation of the PBP active site halts cross-linking and is treponemicidal,
    which is why a single penicillin injection cures all stages.
  role: therapeutic_vulnerability
  conforms_to: "bacterial_cell_wall_synthesis_inhibition#Peptidoglycan Cross-Linking by Penicillin-Binding Proteins"
  biological_processes:
  - preferred_term: Peptidoglycan-Based Cell Wall Biogenesis
    term:
      id: GO:0009273
      label: peptidoglycan-based cell wall biogenesis
  evidence:
  - reference: PMID:22203377
    reference_title: "From the regulation of peptidoglycan synthesis to bacterial growth and morphology."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      although glycan chain polymerization occurs in the absence of
      transpeptidation (for example, in the presence of penicillin), efficient
      transpeptidation requires ongoing GTase reactions
    explanation: >-
      Establishes that beta-lactams (penicillin) act by blocking PBP
      transpeptidation, the cross-linking step this node represents. Evidence
      source is OTHER as this is a review article.
phenotypes:
- name: Papule
  category: Dermatologic
  description: The primary lesion begins as a papule at the inoculation site.
  phenotype_term:
    preferred_term: Papule
    term:
      id: HP:0200034
      label: Papule
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      the pinta primary lesion is an itchy, scaly papule or plaque that expands
      to greater than 10 cm but does not ulcerate
    explanation: Names the papular form of the primary lesion.
- name: Skin plaque
  category: Dermatologic
  description: >-
    The primary lesion expands into a scaly plaque exceeding 10 cm without
    ulcerating, which distinguishes it from the primary lesion of yaws.
  phenotype_term:
    preferred_term: Skin plaque
    term:
      id: HP:0200035
      label: Skin plaque
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      the pinta primary lesion is an itchy, scaly papule or plaque that expands
      to greater than 10 cm but does not ulcerate
    explanation: Names the plaque form and its size, and records the absence of ulceration.
- name: Scaling skin
  category: Dermatologic
  description: The primary and secondary lesions are scaly.
  phenotype_term:
    preferred_term: Scaling skin
    term:
      id: HP:0040189
      label: Scaling skin
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      the pinta primary lesion is an itchy, scaly papule or plaque that expands
      to greater than 10 cm but does not ulcerate
    explanation: Records the scaly character of the primary lesion.
- name: Pruritus
  category: Dermatologic
  description: The primary lesion is itchy.
  phenotype_term:
    preferred_term: Pruritus
    term:
      id: HP:0000989
      label: Pruritus
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      the pinta primary lesion is an itchy, scaly papule or plaque that expands
      to greater than 10 cm but does not ulcerate
    explanation: Records pruritus as a feature of the primary lesion.
- name: Skin rash
  category: Dermatologic
  description: >-
    Secondary disseminated lesions (pintids) form a generalized eruption that
    persists and remains infectious for years.
  phenotype_term:
    preferred_term: Skin rash
    term:
      id: HP:0000988
      label: Skin rash
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      In pinta, lesions remain active and infectious for many years
    explanation: Supports a persistent disseminated cutaneous eruption.
- name: Hypopigmentation of the skin
  category: Dermatologic
  frequency: FREQUENT
  description: Extensive depigmentation develops as lesions age.
  phenotype_term:
    preferred_term: Hypopigmentation of the skin
    term:
      id: HP:0001010
      label: Hypopigmentation of the skin
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "leading to extensive depigmentation and acral dyschromia"
    explanation: Directly reports extensive depigmentation in pinta.
- name: Hyperpigmentation of the skin
  category: Dermatologic
  description: >-
    Dyschromia in pinta is mixed - hyperpigmented and hypopigmented areas
    coexist, and both are captured by the term dyschromia used in the source.
  phenotype_term:
    preferred_term: Hyperpigmentation of the skin
    term:
      id: HP:0000953
      label: Hyperpigmentation of the skin
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "leading to extensive depigmentation and acral dyschromia"
    explanation: >-
      Supports mixed pigmentary change. The source says dyschromia rather than
      hyperpigmentation specifically, so this binding is the narrower reading
      of a broader term and should not be read as a separately reported finding.
- name: Hypopigmented skin patches
  category: Dermatologic
  description: >-
    Late disease is defined by achromic patches that persist after cure and
    account for pinta's lasting disfigurement.
  phenotype_term:
    preferred_term: Hypopigmented skin patches
    term:
      id: HP:0001053
      label: Hypopigmented skin patches
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "leading to extensive depigmentation and acral dyschromia"
    explanation: Supports patchy depigmentation as the late cutaneous outcome.
- name: Diffuse skin atrophy
  category: Dermatologic
  description: Late lesions show epidermal atrophy accompanying the pigment loss.
  phenotype_term:
    preferred_term: Diffuse skin atrophy
    term:
      id: HP:0007488
      label: Diffuse skin atrophy
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Epidermal atrophy and the presence of many melanophages in the dermis are
      typical findings of late-stage pinta
    explanation: Reports epidermal atrophy as a typical late-stage finding.
- name: Lymphadenopathy
  category: Hematologic
  description: Regional lymphadenopathy commonly accompanies the primary lesion.
  phenotype_term:
    preferred_term: Regional lymphadenopathy
    term:
      id: HP:0002716
      label: Lymphadenopathy
  evidence:
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      expands to a diameter of 10 cm or greater. Regional lymphadenopathy is
      common.
    explanation: >-
      Reports regional lymphadenopathy in the primary stage. Bound to the
      general HP term because HP carries no regional-lymphadenopathy class, so
      the regional qualifier is held in preferred_term.
- name: Hyperkeratosis
  category: Dermatologic
  description: Late lesions may show hyperkeratosis alongside atrophy and pigment loss.
  phenotype_term:
    preferred_term: Hyperkeratosis
    term:
      id: HP:0000962
      label: Hyperkeratosis
  evidence:
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      The late (tertiary) stage usually develops 2–5 years after initial
      infection and is characterized by pigmentary abnormalities (i.e., from
      dyschromic treponeme-containing lesions to achromic treponeme-free
      lesions), skin atrophy, and hyperkeratosis.
    explanation: Names hyperkeratosis directly as a feature of the late stage.
- name: Abnormality of skin pigmentation
  category: Dermatologic
  frequency: FREQUENT
  description: >-
    The defining clinical feature of pinta, and the one that gives the disease
    its Spanish and Portuguese names.
  phenotype_term:
    preferred_term: Abnormality of skin pigmentation
    term:
      id: HP:0001000
      label: Abnormality of skin pigmentation
  evidence:
  - reference: PMID:23332859
    reference_title: "From badge of pride to cause of stigma: combatting mal del pinto in Mexico."
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "Mal del pinto is a dermatological disease characterized by discoloured patches of skin on the face and body."
    explanation: The abstract describes discoloured patches of skin in pinta.
histopathology:
- name: Basal-cell melanin loss with liquefaction degeneration
  description: >-
    The early lesion shows loss of melanin from basal keratinocytes together
    with liquefaction degeneration of the basal layer.
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "In the early lesion, there is loss of melanin in basal cells and liquefaction degeneration."
    explanation: The histological description of the early pinta lesion.
- name: Epidermal atrophy with dermal melanophages
  description: >-
    The late lesion shows a thinned epidermis and abundant melanin-laden
    macrophages in the dermis.
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Epidermal atrophy and the presence of many melanophages in the dermis are
      typical findings of late-stage pinta
    explanation: The histological description of the late pinta lesion.
- name: Absence of ulceration
  description: >-
    Unlike yaws, pinta lesions do not ulcerate. This is a negative finding that
    distinguishes the two on biopsy as well as clinically.
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "In pinta, there is no ulcer formation comparable to that in yaws"
    explanation: States the absence of ulceration that separates pinta from yaws histologically.
diagnosis:
- name: Clinical and epidemiologic diagnosis
  description: >-
    Diagnosis rests on compatible lesion morphology together with residence in,
    or origin from, a historically endemic area, plus exclusion of the
    dyspigmentation mimics. Serology confirms treponemal infection but cannot
    name which treponematosis it is.
  evidence:
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      U.S. physicians should consider pinta in the differential diagnosis of
      skin diseases in children and adolescents who come from areas where pinta
      was previously endemic and have a positive reaction in serological tests
      for syphilis.
    explanation: >-
      Describes the actual diagnostic pathway - endemic-area origin plus
      reactive syphilis serology plus compatible skin disease.
- name: Treponemal and nontreponemal serology
  description: >-
    The same tests used for syphilis (RPR or VDRL, confirmed by TPHA, TPPA or
    FTA-Abs) are used for pinta. Their central limitation is that they are
    positive in every treponematosis, so a reactive result establishes
    treponemal infection but not which one.
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      treponemal tests TPHA, TPPA, and FTA-Abs are more specific, but remain
      positive for life
    explanation: Names the confirmatory treponemal tests used across the endemic treponematoses.
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      serological tests cannot distinguish between endemic treponematoses
      infections and syphilis
    explanation: >-
      States the limitation that makes serology non-diagnostic for pinta
      specifically and forces reliance on clinical and epidemiologic context.
differential_diagnoses:
- name: Tinea versicolor
  description: A common tropical dyspigmentation that mimics the dyschromic lesions of pinta.
  distinguishing_features:
  - Superficial scale demonstrating hyphae and spores on potassium hydroxide microscopy
  - Non-reactive treponemal serology
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Disorders associated with dyspigmentation, such as
      tinea versicolor, vitiligo, melasma, and leprosy, are often in the
      differential diagnosis of pinta
    explanation: Names tinea versicolor as a differential for pinta.
- name: Vitiligo
  description: >-
    Acquired depigmented macules that closely resemble the achromic patches of
    late pinta.
  distinguishing_features:
  - No preceding papular or plaque stage
  - No endemic exposure history
  - Non-reactive treponemal serology
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Disorders associated with dyspigmentation, such as
      tinea versicolor, vitiligo, melasma, and leprosy, are often in the
      differential diagnosis of pinta
    explanation: Names vitiligo as a differential for pinta.
- name: Melasma
  description: Acquired hyperpigmentation that overlaps with the dyschromic phase of pinta.
  distinguishing_features:
  - Symmetric facial distribution
  - Association with pregnancy or sun exposure
  - Non-reactive treponemal serology
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Disorders associated with dyspigmentation, such as
      tinea versicolor, vitiligo, melasma, and leprosy, are often in the
      differential diagnosis of pinta
    explanation: Names melasma as a differential for pinta.
- name: Leprosy
  description: >-
    Hypopigmented patches of tuberculoid leprosy are the most consequential
    mimic, since the two share endemic settings and both are treatable
    infections.
  distinguishing_features:
  - Sensory loss within the hypopigmented patch, which does not occur in pinta
  - Peripheral nerve thickening
  - Acid-fast bacilli on slit-skin smear
  evidence:
  - reference: DOI:10.1371/journal.pntd.0002283
    reference_title: "Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Disorders associated with dyspigmentation, such as
      tinea versicolor, vitiligo, melasma, and leprosy, are often in the
      differential diagnosis of pinta
    explanation: Names leprosy as a differential for pinta.
treatments:
- name: Penicillin injection
  description: >-
    A single intramuscular injection of long-acting benzathine penicillin
    cures every stage of pinta and renders the lesions non-infectious within a
    day. It does not restore the pigment lost in late disease, so treatment
    ends transmission and halts progression without undoing the disfigurement
    that is the disease's lasting burden.
  treatment_term:
    preferred_term: Pharmacotherapy
    term:
      id: NCIT:C15986
      label: Pharmacotherapy
    therapeutic_agent:
    - preferred_term: benzylpenicillin
      term:
        id: CHEBI:18208
        label: benzylpenicillin
  therapeutic_modality: SMALL_MOLECULE
  target_mechanisms:
  - target: Treponemal Peptidoglycan Cross-Linking (Beta-Lactam Target)
    description: >-
      Penicillin acylates the treponemal PBP transpeptidase, blocking
      peptidoglycan cross-linking and killing the organism.
  evidence:
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "All stages of pinta are treatable with a single intramuscular injection of penicillin."
    explanation: The abstract states that penicillin injection treats pinta.
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "which renders the lesions noninfectious in less than 24 hours"
    explanation: Quantifies how quickly treatment ends infectiousness.
  - reference: PMID:26304920
    reference_title: "Pinta: Latin America's Forgotten Disease?"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: >-
      Although early pinta lesions heal within several months after penicillin
      administration, this treatment cannot reverse the skin changes of late
      pinta that can stigmatize those who were infected.
    explanation: >-
      Establishes the limit of cure - early lesions heal, late pigmentary
      change does not - which is why this entry treats the residual
      disfigurement as an outcome rather than as treatment failure.
notes: >-
  Curation gaps and boundary notes.

  Why the agent is bound at species rank. T. carateum is bound to
  NCBITaxon:3712027 rather than to a T. pallidum subspecies node, matching the
  literature's own position: the separate species rank is retained because the
  organism has never been cultivated or sequenced, so the genomic comparison
  that assigned pertenue and endemicum to subspecies rank has never been
  performed on it. This entry therefore asserts neither that T. carateum is a
  distinct species nor that it is a T. pallidum subspecies. Any future entry
  should treat a change in that classification as new evidence rather than as
  a correction.

  No azithromycin treatment is recorded. Single-dose oral azithromycin
  underpins the WHO yaws eradication strategy and is curated on the Yaws
  entry, but the sources reviewed here document only penicillin for pinta.
  Adding azithromycin by analogy with yaws would be an inference, not a
  citation, so it is deliberately absent.

  No clinical trials, datasets, animal models or computational models. Pinta
  has no modern trial literature, no sequenced isolate, and no model system -
  a direct consequence of the organism being non-cultivable and the disease
  being close to disappearance. These sections are absent because the evidence
  does not exist, not because they were not searched.

  Frequency bands are mostly unset. Only the two pigmentary phenotypes carry
  FREQUENT; the rest are left without a frequency because the available
  literature describes the lesions qualitatively and reports no case-series
  denominators for pinta.

  Hyperpigmentation is a narrower reading of a broader source term. The
  sources report "dyschromia", which covers both directions of pigmentary
  change. HP has no single term for mixed dyschromia at this granularity, so
  both directions are recorded separately and the explanation on the
  hyperpigmentation item records that it derives from the broader word.
references:
- reference: DOI:10.1371/journal.pntd.0002283
  title: 'Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta'
  found_in:
  - Pinta-deep-research-falcon.md
  findings:
  - statement: >-
      Pinta is skin-limited, transmitted by direct skin contact, and produces
      early basal-cell melanin loss followed by late epidermal atrophy with
      dermal melanophages.
    supporting_text: "In the early lesion, there is loss of melanin in basal cells and liquefaction degeneration."
- reference: DOI:10.15585/mmwr.rr7301a1
  title: CDC Laboratory Recommendations for Syphilis Testing, United States, 2024
  found_in:
  - Pinta-deep-research-falcon.md
  findings:
  - statement: Pinta remains present but rare in tropical Latin America.
    supporting_text: >-
      Treponema carateum infection results in pinta which, although rare, is
      found in tropical areas of Latin America
📚

References & Deep Research

References

2
DOI:10.1371/journal.pntd.0002283
Advances in the Diagnosis of Endemic Treponematoses: Yaws, Bejel, and Pinta
1 finding
Pinta is skin-limited, transmitted by direct skin contact, and produces early basal-cell melanin loss followed by late epidermal atrophy with dermal melanophages.
"In the early lesion, there is loss of melanin in basal cells and liquefaction degeneration."
DOI:10.15585/mmwr.rr7301a1
CDC Laboratory Recommendations for Syphilis Testing, United States, 2024
1 finding
Pinta remains present but rare in tropical Latin America.
"Treponema carateum infection results in pinta which, although rare, is found in tropical areas of Latin America"

Deep Research

1

Deep research results are used as seeds for research; they do not undergo the same validation as the main records and may contain errors. How we use deep research.

Evaluations and curation notes (1)

Expand Pinta from stub to full entry; bind T. carateum to NCBITaxon · 2026-09-01T07:53:09Z · View source

Pinta was the thinnest entry in the treponematoses group at 119 lines: one pathophysiology node, one phenotype bound to the most generic pigmentation term available (HP:0001000), and a references block whose four findings all quoted the paper title as their own supporting text. Agent binding. Treponema carateum previously had no infectious_agent_term, alone among the four treponematoses. Bound to NCBITaxon:3712027, verified live against OLS rather than taken from the deep-research report. The entry deliberately asserts neither that T. carateum is a distinct species nor that it is a T. pallidum subspecies: the literature retains separate species rank only because the organism has never been cultivated or sequenced, so the genomic comparison that assigned pertenue and endemicum has never been run. That reasoning is recorded in notes so a future reclassification reads as new evidence rather than as a correction here. Content added. Transmission (direct skin-to-skin contact), two structured prevalence records (a 1980s Panamanian survey at 20%, and an explicit NOT_YET_DOCUMENTED record for current burden), epidemiology, the three clinical stages, three histopathology findings including the negative finding that pinta lesions do not ulcerate, two diagnosis entries centred on the fact that serology cannot separate the treponematoses, and four differential diagnoses drawn from the dyspigmentation mimics. Pathophysiology went from one node to five, chained: cutaneous inoculation to intradermal dissemination to melanocyte injury and basal melanin loss to dermal melanophage accumulation with epidermal atrophy, plus the pre-existing beta-lactam target node that conforms to bacterial_cell_wall_synthesis_inhibition. The pigmentary chain is what makes pinta mechanistically distinct from its siblings, and it was entirely absent before. Phenotypes went from one to twelve. Five of the CURIEs suggested by the Falcon deep-research report named different concepts entirely and were not used: HP:0000952 is Jaundice not hyperpigmentation, HP:0000953 is hyperpigmentation not abnormal skin pigmentation, HP:0000962 is Hyperkeratosis not skin atrophy, HP:0000958 is Dry skin not scaly skin, and HP:0032316 is Family history not plaque of skin. Correct terms were found by OLS search and every binding passes validate-terms. Note HP:0000962 does appear in the entry, but as Hyperkeratosis, the concept it actually names, not as the skin atrophy the report labelled it. Evidence. Two references were newly fetched (DOI:10.1371/journal.pntd.0002283 and DOI:10.15585/mmwr.rr7301a1), both returning full text. Running the reference validator also upgraded PMID:26304920 (Stamm) from abstract_only to green-OA full text, which turned out to matter: the full text supplies the stage intervals (about 3 weeks to the primary lesion, several months to the secondary stage, 2-5 years to late disease), regional lymphadenopathy, hyperkeratosis, the sub-24-hour loss of infectiousness after penicillin, and the explicit statement that treatment cannot reverse late skin changes. Several claims that had been written as prose without a citation are now cited from it, and two phenotypes were added. All 59 snippets were verified as exact substrings of their cached references under whitespace and dash normalisation. This had to be done manually: linkml-reference-validator skips the DOI: prefix, so 38 of them are reported as 'skipped by prefix' and are not covered by the automated gate at all. Snippets were also checked to contain no bracketed citation markers, since the validator strips bracketed content from the query side but not from the cached text, and to avoid PDF hyphenated line breaks. Two entries dropped from references. DOI:10.1111/ijd.15264 (Rosa 2021) caches as content_type: unavailable so no snippet can be verified against it, and DOI:10.3389/fimmu.2023.1126170 is about syphilis, not pinta; its recorded finding quoted a sentence naming T. pallidum subsp. pallidum. Deliberate omissions recorded in notes: no azithromycin treatment (documented for yaws, not for pinta in the sources reviewed; adding it would be inference), and no clinical_trials, datasets, animal_models or computational_models, because a non-cultivable organism with no sequenced isolate has none. Validation run: linkml-validate, just validate-terms, just count-verified-snippets, just validate-references, check-duplicate-keys, check-entity-refs, check-causal-targets, check-qualifier-terms, check-enum-values, check-folded-hyphens, check-snippet-length, check-title-snippets.

Falcon ▸
1. Disease Information
Edison Scientific Literature 25 citations 2026-04-04T16:04:33.674447

1. Disease Information

1.1 Definition and overview (current understanding)

Pinta is a neglected chronic skin disease and the most benign of the endemic treponematoses, in that it is classically described as involving only the skin (without the destructive bone/cartilage manifestations typical of late yaws). It has been described historically in Latin America for centuries and is also referred to as “mal del pinto” and “carate.” (stamm2015pintalatinamericas pages 1-3, rosa2021maldepinta pages 1-2)

1.2 Key identifiers (OMIM, Orphanet, ICD-10/ICD-11, MeSH, MONDO)

Within the retrieved full-text evidence set, explicit ontology/coding identifiers (MONDO, MeSH descriptor IDs, ICD-10/ICD-11 codes, Orphanet, OMIM) were not directly stated, and therefore cannot be asserted here with citations. The most authoritative retrieved recent resource is the CDC’s 2024 laboratory recommendations, which provide organism-level taxonomy and a brief epidemiologic locator but do not provide ICD/MeSH/MONDO mappings. (papp2024cdclaboratoryrecommendations pages 3-4, papp2024cdclaboratoryrecommendations pages 25-26)

1.3 Synonyms / alternative names

Common synonyms reported in peer-reviewed literature include “mal del pinto” and “carate.” (stamm2015pintalatinamericas pages 1-3, rosa2021maldepinta pages 1-2)

1.4 Evidence source type

Most of the disease-level information for pinta in the retrieved set is aggregated from reviews/perspectives and clinical microbiology/dermatology references, with limited modern case-based literature (e.g., a 2021 case report). (stamm2015pintalatinamericas pages 1-3, rosa2021maldepinta pages 1-2)

2. Etiology

2.1 Disease causal factors

Primary cause: infection with the spirochete Treponema carateum. (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 2-3, papp2024cdclaboratoryrecommendations pages 3-4)

Taxonomic framing (current debate): Recent immunology review articles emphasize that the treponemal diseases are genetically and antigenically highly similar and historically were considered related; one 2023 review explicitly states that pinta is caused by “a different species … namely Treponema carateum.” (avilanieto2023syphilisvaccinechallenges pages 1-2)

2.2 Risk factors (human clinical/epidemiologic)

Transmission route: nonvenereal direct skin-to-skin contact with infectious lesions. (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 2-3, papp2024cdclaboratoryrecommendations pages 3-4)

Sociodemographic/environmental context: classically described in poor rural tropical communities, often acquired in childhood or adolescence. (stamm2015pintalatinamericas pages 1-3, rosa2021maldepinta pages 1-2)

Geography as a risk determinant: tropical Latin America/Central and South America (including persistence in remote settings). CDC 2024 states: “Treponema carateum infection results in pinta which, although rare, is found in tropical areas of Latin America.” (papp2024cdclaboratoryrecommendations pages 3-4)

2.3 Protective factors

No pinta-specific protective genetic variants, host factors, or environmental protective factors were identified in the retrieved evidence set.

2.4 Gene–environment interactions

No host gene–environment interaction evidence was identified in the retrieved evidence set.

3. Phenotypes

3.1 Clinical spectrum and staging

Pinta is commonly described as a staged cutaneous illness: - Primary stage: papules/erythematous scaly plaques at the inoculation site appearing after infection (classically around weeks). (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 2-3) - Secondary stage: disseminated lesions (“pintids”) with pigmentary changes developing months after infection; lesions may persist and remain infectious for years. (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 2-3) - Late/tertiary stage: dyschromia/achromia and cutaneous atrophy occurring years after infection (e.g., 2–5 years in one classic description). (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 3-5)

A 2021 dermatology case report similarly emphasizes a three-stage evolution with early localized lesions, later generalized rash with hyper-/hypopigmented lesions, and late pigmentary change that can resemble vitiligo. (rosa2021maldepinta pages 1-2)

3.2 Differential diagnosis

Because late pinta can manifest as dyschromic patches, key differentials include tinea versicolor, vitiligo, melasma, leprosy, and other dermatoses. (mitja2013advancesinthe pages 2-3)

3.3 Histopathology (biopsy phenotypes)

Mitjà et al. summarize stage-linked pathology, including early “loss of melanin in basal cells and liquefaction degeneration” and late “epidermal atrophy and the presence of many melanophages in the dermis.” (mitja2013advancesinthe pages 3-5)

3.4 Suggested HPO terms

A staged phenotype-to-HPO mapping based on the retrieved literature is provided below.

Stage/phenotype Description Timing Suggested HPO terms Evidence (citation IDs) URL Publication date
Primary lesion Initial pruritic, erythematous, scaly papule or plaque at inoculation site; enlarges and typically does not ulcerate ~3 weeks after infection; alternatively reported as 1–8 weeks after infection Pruritus (HP:0000989); Erythema (HP:0010783); Papule (HP:0200034); Plaque of skin (HP:0032316); Scaly skin (HP:0000958) (stamm2015pintalatinamericas pages 1-3, rosa2021maldepinta pages 1-2, mitja2013advancesinthe pages 2-3, mitja2013advancesinthe pages 3-5) https://doi.org/10.4269/ajtmh.15-0329; https://doi.org/10.1111/ijd.15264; https://doi.org/10.1371/journal.pntd.0002283 2015-11; 2021-11; 2013-10
Secondary disseminated lesions (“pintids”) Months to years after primary lesion, disseminated skin lesions develop with generalized rash and pigmentary change; lesions may remain active/infectious for years Months after infection in classic staging; generalized rash reported over 2–4 years Rash (HP:0000988); Abnormal skin pigmentation (HP:0000953); Hyperpigmentation of the skin (HP:0000952); Hypopigmentation of the skin (HP:0001010); Acral dyschromia (suggested, mapped broadly to abnormal skin pigmentation) (stamm2015pintalatinamericas pages 1-3, rosa2021maldepinta pages 1-2, mitja2013advancesinthe pages 2-3) https://doi.org/10.4269/ajtmh.15-0329; https://doi.org/10.1111/ijd.15264; https://doi.org/10.1371/journal.pntd.0002283 2015-11; 2021-11; 2013-10
Late pigmentary disease Late/tertiary pinta characterized by dyschromia, achromic or hypochromic lesions, and persistent depigmentation; cosmetic disfigurement may remain despite cure Usually 2–5 years after infection; other reports describe 3–10 years for late changes Dyschromia (suggested, mapped to Abnormal skin pigmentation HP:0000953); Achromia/Hypopigmentation of the skin (HP:0001010); Hyperpigmentation of the skin (HP:0000952); Vitiligo-like depigmentation (suggested, mapped to HP:0001010) (stamm2015pintalatinamericas pages 1-3, rosa2021maldepinta pages 1-2, mitja2013advancesinthe pages 2-3) https://doi.org/10.4269/ajtmh.15-0329; https://doi.org/10.1111/ijd.15264; https://doi.org/10.1371/journal.pntd.0002283 2015-11; 2021-11; 2013-10
Skin atrophy Chronic late lesions may show cutaneous thinning/atrophy accompanying pigment loss Late stage, usually years after untreated infection Skin atrophy (HP:0000962) (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 3-5) https://doi.org/10.4269/ajtmh.15-0329; https://doi.org/10.1371/journal.pntd.0002283 2015-11; 2013-10
Histopathologic early lesion correlate Early lesions show loss of melanin in basal cells and liquefaction degeneration Early/primary stage biopsy finding Decreased skin pigmentation (suggested, mapped to Hypopigmentation of the skin HP:0001010) (mitja2013advancesinthe pages 3-5) https://doi.org/10.1371/journal.pntd.0002283 2013-10
Histopathologic late lesion correlate Late lesions show epidermal atrophy and numerous dermal melanophages Late stage biopsy finding Skin atrophy (HP:0000962); Abnormality of skin pigmentation (HP:0000953) (mitja2013advancesinthe pages 3-5) https://doi.org/10.1371/journal.pntd.0002283 2013-10
Disease distribution/severity pattern Pinta is generally the most benign endemic treponematosis and is limited to the skin, without the ulcerative or destructive bone disease typical of some other treponematoses Chronic, slowly progressive if untreated Cutaneous abnormality (HP:0011121) (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 2-3, mitja2013advancesinthe pages 3-5) https://doi.org/10.4269/ajtmh.15-0329; https://doi.org/10.1371/journal.pntd.0002283 2015-11; 2013-10
Prognostic note on treatment response Early lesions heal over months after treatment, but late pigmentary changes may be irreversible or only partially reversible After therapy; chronic untreated disease worsens cosmetically over years Abnormal skin pigmentation (HP:0000953) (rosa2021maldepinta pages 1-2, stamm2015pintalatinamericas pages 3-5) https://doi.org/10.1111/ijd.15264; https://doi.org/10.4269/ajtmh.15-0329 2021-11; 2015-11

Table: This table summarizes the main clinical stages and phenotypes of pinta, with suggested HPO mappings, timing, and severity/progression notes. It is useful for phenotype annotation and natural-history curation in a disease knowledge base.

3.5 Quality of life impact

The retrieved evidence emphasizes disfigurement/cosmetic persistence of late pigmentary changes even after cure, implying psychosocial and quality-of-life impact; however, no quantitative QoL instruments (e.g., SF-36, EQ-5D) were identified for pinta in the retrieved set. (rosa2021maldepinta pages 1-2, stamm2015pintalatinamericas pages 3-5)

4. Genetic / Molecular Information

4.1 Human causal genes and pathogenic variants

Not applicable as a primary genetic disorder. No host genetic susceptibility loci were identified in the retrieved evidence set.

4.2 Pathogen molecular data and taxonomy (what is known; key gaps)

  • Not-yet-cultivable / no extant isolates in common use: The 2015 pinta perspective notes that T. carateum is “not-yet-cultivable” and that isolates are not available for study, limiting experimentation and genomic characterization. (stamm2015pintalatinamericas pages 1-3, stamm2015pintalatinamericas pages 3-5)
  • Serologic and morphologic indistinguishability: T. carateum is described as morphologically and serologically indistinguishable from T. pallidum subspecies agents of syphilis/yaws/bejel, which contributes to diagnostic ambiguity. (stamm2015pintalatinamericas pages 1-3)
  • Insufficient genomic knowledge for confident subspecies placement: Both Mitjà et al. and Stamm emphasize that molecular knowledge is insufficient to confidently classify T. carateum as a T. pallidum subspecies, and that genomic differentiation methods used for T. pallidum subspecies have not been applied due to lack of isolates/genomic data. (mitja2013advancesinthe pages 3-5, stamm2015pintalatinamericas pages 1-3)

4.3 Suggested ontology terms (molecular/cellular)

Because pinta is a skin-limited treponemal infection with pigmentary pathology: - GO (Biological Process) suggestions (inferred from histology/clinical pathology): inflammatory response; immune response; melanin biosynthetic process (as a downstream phenotype driver); response to bacterium. (mitja2013advancesinthe pages 3-5) - CL (Cell Ontology) suggestions: melanocyte; macrophage (consistent with dermal melanophages); plasma cell (reported in biopsy infiltrates in a 2021 case). (rosa2021maldepinta pages 1-2, mitja2013advancesinthe pages 3-5)

5. Environmental Information

5.1 Non-genetic contributing factors

The evidence emphasizes exposure in tropical rural environments and direct skin contact transmission, rather than toxins/radiation/pollution. (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 2-3)

5.2 Infectious agents

Primary agent: Treponema carateum. (stamm2015pintalatinamericas pages 1-3, papp2024cdclaboratoryrecommendations pages 3-4)

6. Mechanism / Pathophysiology

6.1 Causal chain (clinical mechanism summary)

1) Initial infection via direct skin-to-skin contact introduces T. carateum into skin. (stamm2015pintalatinamericas pages 1-3, papp2024cdclaboratoryrecommendations pages 3-4) 2) Primary localized lesion develops (scaly papule/plaque) without typical ulceration. (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 2-3, mitja2013advancesinthe pages 3-5) 3) Dissemination within skin produces secondary lesions (“pintids”) and pigmentary change. (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 2-3) 4) Chronic inflammatory and pigmentary remodeling results in long-lasting dyschromia/achromia and possible skin atrophy, with histology including melanophages in dermis and epidermal atrophy in late lesions. (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 3-5)

6.2 Upstream vs downstream mechanisms

  • Upstream: bacterial infection and persistence in skin; local immune response. (mitja2013advancesinthe pages 2-3)
  • Downstream: pigment loss/redistribution and structural skin changes (atrophy; melanophages). (mitja2013advancesinthe pages 3-5)

6.3 Molecular profiling / omics

No pinta-specific transcriptomic/proteomic/metabolomic datasets were identified in the retrieved evidence set.

7. Anatomical Structures Affected

7.1 Organ/system level

Primary affected organ: skin (cutaneous-only disease emphasized in multiple sources). (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 2-3)

7.2 Tissue/cell level

Affected tissues/cell processes include epidermis/dermis with pigmentary abnormalities; histology in late lesions includes melanophages. (mitja2013advancesinthe pages 3-5)

7.3 Suggested UBERON / GO CC

  • UBERON: skin of body.
  • GO Cellular Component suggestions: epidermis; dermis; melanosome (as a pigment-related cellular component inference). (mitja2013advancesinthe pages 3-5)

8. Temporal Development (Natural History)

8.1 Onset and course

  • Onset: classically weeks after infection (papules/plaques), often in childhood/adolescence in endemic settings. (stamm2015pintalatinamericas pages 1-3, rosa2021maldepinta pages 1-2)
  • Progression: chronic evolution over years, with late pigmentary sequelae developing years after initial infection if untreated. (stamm2015pintalatinamericas pages 1-3, rosa2021maldepinta pages 1-2)

8.2 Remission patterns

  • Treatment-induced remission: single-dose penicillin can halt infection and render lesions noninfectious rapidly; however, pigmentary changes may persist. (stamm2015pintalatinamericas pages 3-5, rosa2021maldepinta pages 1-2)

9. Inheritance and Population

9.1 Epidemiology (best-available quantitative data)

Modern surveillance data are limited; however, the retrieved literature provides several quantitative historical/field observations: - Historical burden: an estimated ~1 million cases occurred in Mexico, Central America, and northern South America in the 1950s (historical estimate cited in a 2015 perspective). (stamm2015pintalatinamericas pages 1-3) - Field prevalence example: a Panama village survey (1982–83) reported ~20% of the population with clinical evidence of pinta (active/inactive), cited in both a 2015 perspective and the 2013 PLoS NTD review. (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 2-3) - Current burden: the 2015 perspective emphasizes that the “current prevalence … is unknown due to the lack of surveillance data.” (stamm2015pintalatinamericas pages 1-3)

9.2 Demographics

A 2013 review reports peak incidence in adults (15–50 years), while other sources emphasize acquisition in children/adolescents; these differences may reflect heterogeneous data sources and limited modern surveillance. (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 2-3)

9.3 Geographic distribution

Pinta is primarily associated with tropical areas of Latin America/Central and South America; CDC 2024 characterizes it as rare in tropical Latin America. (mitja2013advancesinthe pages 2-3, papp2024cdclaboratoryrecommendations pages 3-4)

10. Diagnostics

10.1 Clinical diagnosis

Diagnosis relies on compatible clinical lesions (scaly plaques progressing to dyschromic patches) plus epidemiologic context (residence/travel in historically endemic regions) and exclusion of mimics such as tinea versicolor or vitiligo. (mitja2013advancesinthe pages 2-3)

10.2 Serologic testing (standard approach; key limitation)

Across endemic treponematoses, diagnostics generally follow syphilis paradigms using both nontreponemal and treponemal tests: - Nontreponemal tests: RPR, VDRL. - Treponemal tests: TPHA/TPPA, FTA-Abs, ELISA. A core limitation is repeatedly emphasized: serology cannot distinguish pinta from other endemic treponematoses or venereal syphilis. (mitja2013advancesinthe pages 3-5, stamm2015pintalatinamericas pages 1-3)

A 2021 pinta case report illustrates this diagnostic approach with very high VDRL titer and positive FTA-Abs IgM/IgG in a compatible clinical context. (rosa2021maldepinta pages 1-2)

10.3 Direct detection / microscopy / molecular methods

Mitjà et al. emphasize that direct methods are constrained by inability to culture treponemes and the impracticality/low sensitivity of some direct tests in field settings; they note increasing use of PCR and genomic fingerprinting for endemic treponematoses in general, but definitive molecular diagnosis remains limited by availability. (mitja2013advancesinthe pages 1-2, mitja2013advancesinthe pages 3-5)

Recent (2024) authoritative diagnostic context: The CDC laboratory recommendations (2024) describe that direct detection is evolving toward molecular methods while serology remains central; the report also notes there are no FDA-cleared molecular tests marketed in the U.S. for T. pallidum (which has implications for distinguishing among treponematoses when patients have relevant travel histories). (papp2024cdclaboratoryrecommendations pages 25-26)

10.4 Differential diagnosis

Important differentials include tinea versicolor, vitiligo, melasma, leprosy, and other dermatoses causing pigmentary change. (mitja2013advancesinthe pages 2-3)

11. Outcome / Prognosis

11.1 Mortality/survival

No mortality or survival statistics specific to pinta were identified in the retrieved evidence set; pinta is generally characterized as skin-limited and “benign” relative to other treponematoses. (stamm2015pintalatinamericas pages 1-3)

11.2 Morbidity and complications

The main long-term morbidity described is chronic pigmentary change (dyschromia/achromia) and possible skin atrophy, which may be persistent despite cure. (stamm2015pintalatinamericas pages 3-5, rosa2021maldepinta pages 1-2)

12. Treatment

12.1 First-line therapy (real-world standard)

Long-acting intramuscular benzathine penicillin is widely described as curative across stages: - A 2015 perspective reports that a single intramuscular dose can render lesions noninfectious in <24 hours and provides dosing guidance (adults 1.2 million units; children 0.6 million units). (stamm2015pintalatinamericas pages 3-5) - A 2021 case report describes treatment with benzathine penicillin 2.4 million units IM and similarly notes rapid loss of infectiousness (within ~24 hours). (rosa2021maldepinta pages 1-2)

12.2 Alternatives / mass drug administration implications

A key implementation-relevant point is that mass azithromycin campaigns for yaws eradication could also affect pinta if T. carateum is azithromycin-sensitive (not directly proven in the retrieved evidence, but proposed as plausible). (stamm2015pintalatinamericas pages 3-5)

12.3 Treatment outcomes

Early lesions may heal over months after treatment; late pigmentary changes may persist. (stamm2015pintalatinamericas pages 3-5, rosa2021maldepinta pages 1-2)

12.4 Suggested MAXO terms (treatment actions)

  • Intramuscular benzathine penicillin therapy.
  • Antibiotic therapy (systemic).
  • Public health mass drug administration (azithromycin-based), as a plausible co-benefit when targeting yaws in co-endemic settings. (stamm2015pintalatinamericas pages 3-5)

12.5 Clinical trials

No pinta-specific interventional clinical trials were identified in the retrieved evidence set.

13. Prevention

13.1 Primary prevention

No vaccine exists for pinta. Prevention is primarily via reducing skin-to-skin exposure to infectious lesions and through community-level detection and treatment strategies. (stamm2015pintalatinamericas pages 1-3, papp2024cdclaboratoryrecommendations pages 3-4)

13.2 Public health control (historical and current implementation)

  • Historical implementation: mass penicillin campaigns in the 1950s–1960s markedly reduced endemic treponematoses and nearly eradicated them in many regions, but resurgence occurred where political commitment/resources waned. (mitja2013advancesinthe pages 1-2, stamm2015pintalatinamericas pages 3-5)
  • Modern implementation opportunity (indirect): yaws eradication strategies using azithromycin may have spillover benefits for pinta where co-endemic, contingent on antimicrobial susceptibility. (stamm2015pintalatinamericas pages 3-5)

14. Other Species / Natural Disease

No evidence for a non-human animal reservoir or naturally occurring pinta in other species was identified in the retrieved evidence set. (Note: other treponematoses have been discussed in non-human primates in general literature, but pinta-specific evidence was not retrieved here.)

15. Model Organisms

Pinta-specific experimental models are extremely limited in contemporary literature because T. carateum is not available as an isolate and is not cultivable in standard systems; this limits the feasibility of modern animal models, in vitro systems, and functional genomics. (stamm2015pintalatinamericas pages 3-5, stamm2015pintalatinamericas pages 1-3)

Recent developments and latest research (prioritizing 2023–2024)

1) Updated authoritative guidance acknowledging pinta in laboratory diagnostic context (2024): The CDC’s 2024 syphilis laboratory recommendations explicitly remind laboratorians and clinicians that nonvenereal treponematoses exist, and state: “Treponema carateum infection results in pinta which, although rare, is found in tropical areas of Latin America,” emphasizing travel/endemic-area context when interpreting serology and treponemal testing. URL: https://doi.org/10.15585/mmwr.rr7301a1 (Published Feb 2024). (papp2024cdclaboratoryrecommendations pages 3-4, papp2024cdclaboratoryrecommendations pages 1-3)

2) Modern immunology framing of treponemal disease relatedness (2023): A 2023 Frontiers in Immunology review on syphilis vaccines explicitly distinguishes pinta’s etiologic agent at the species level (“Treponema carateum”) while emphasizing the broader high similarity of pathogenic treponemes, reinforcing why serology alone cannot reliably separate treponemal syndromes and why genomic methods are central to treponemal taxonomy. URL: https://doi.org/10.3389/fimmu.2023.1126170 (Published Apr 2023). (avilanieto2023syphilisvaccinechallenges pages 1-2)

3) Genomics advances inform the broader treponemal complex but not pinta directly (2024 evidence set): Recent paleogenomic work on T. pallidum subspecies emphasizes very high sequence identity among syphilis/yaws/bejel genomes and the importance of ancient DNA to resolve evolutionary history; pinta is generally referenced as part of the treponemal disease complex, but the retrieved 2024 ancient-genome evidence does not provide pinta-specific genomes, highlighting the ongoing gap in T. carateum genomic characterization. (barquera2024ancientgenomesrevealb pages 1-4)

Expert interpretation and analysis (authoritative sources)

  • Diagnostic ambiguity is intrinsic to biology, not just test choice: Multiple sources converge that T. carateum infection produces serologic patterns indistinguishable from syphilis and other endemic treponematoses, so clinical epidemiology and careful differential diagnosis are essential to avoid misclassification (e.g., labeling pinta as sexually transmitted syphilis). (stamm2015pintalatinamericas pages 1-3, mitja2013advancesinthe pages 3-5)

  • The major bottleneck for “modernizing” pinta knowledge is lack of isolates/genomes: Reviews repeatedly emphasize that absence of T. carateum isolates and genomic data limits taxonomic certainty, molecular diagnostics, antimicrobial resistance surveillance, and vaccine-relevant antigen discovery, in contrast to accelerating genomics in syphilis/yaws/bejel research. (stamm2015pintalatinamericas pages 3-5, stamm2015pintalatinamericas pages 1-3)

Key abstract quotes (for evidence anchoring)

  • From Mitjà et al. (PLoS Negl Trop Dis, 2013) abstract on endemic treponematoses diagnosis: “Traditionally, the human treponematoses have been differentiated based upon their clinical manifestations and epidemiologic characteristics because the etiologic agents are indistinguishable in the laboratory.” URL: https://doi.org/10.1371/journal.pntd.0002283 (Published Oct 2013). (mitja2013advancesinthe pages 1-2)

Limitations of this report (evidence gaps)

  • Explicit MONDO/MeSH/ICD identifiers for pinta were not found in the retrieved full-text evidence set and therefore are not provided with citations.
  • Pinta-specific modern surveillance estimates (incidence/prevalence post-2000), antimicrobial susceptibility data (e.g., azithromycin MICs), and pathogen genome sequences were not identified in the retrieved evidence set.
  • No pinta-specific clinical trials were identified.

These gaps likely reflect the rarity of modern cases and limited laboratory material availability for T. carateum. (stamm2015pintalatinamericas pages 1-3, papp2024cdclaboratoryrecommendations pages 25-26)

References

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  2. (stamm2015pintalatinamericas pages 3-5): Lola V. Stamm. Pinta: latin america's forgotten disease? The American journal of tropical medicine and hygiene, 93 5:901-3, Nov 2015. URL: https://doi.org/10.4269/ajtmh.15-0329, doi:10.4269/ajtmh.15-0329. This article has 20 citations.

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