Pinta is an infectious disease of the skin. It occurs exclusively in tropical regions. However, due to improved hygienic conditions, the incidence of the disease has greatly decreased.
What is pinta?
The disease gets its name from the Spanish word “pinta,” which means spot. In Colombia, it also goes by the name carate. Pinta is a nonvenereal as well as endemic treponematosis. It is transmitted by the pathogen Treponema carateum. Treponema is a genus of gram-negative bacteria. They belong to the spirochaetes. This type of bacteria is composed of peculiar, helical and very mobile cells. They have a flagellum with which they can move quickly. They are also called screw bacteria. The best-known pathogen of this genus is that of syphilis. The Treponema pathogens were first discovered in Cuba in 1938. The bacterium that causes pinta is very similar to that of syphilis. Serologically, the two diseases are indistinguishable.
Causes
Today, the causes have been scientifically confirmed. However, this has been a long process. Detecting the pathogen proved to be very difficult. The search for the pathogen resembled a discovery tour like that undertaken by Christopher Columbus. Historical writings indicate that a disease of this type must have already existed at the time of the Aztecs. Pinta is an exclusively bacterial infectious disease. The causative agent of Pinta disease is indigenous only to the tropics. However, a few decades ago, it was epidemically widespread across the country. This includes Mexico in particular, as well as other areas in Central and South America. The screw bacterium is transmitted through direct skin contact with infected persons. Open, weeping skin lesions and poor hygienic conditions favor infection and spread of the pathogen. Young children up to the age of five and young adults between the ages of 15 and 30 are particularly affected. Transmission via sexual contact can be largely ruled out.
Symptoms, complaints, and signs
Symptoms of pinta appear exclusively on the skin. Initially, papules form on the skin – these are called primary lesions. They can grow to several centimeters in size as they progress. The individual papules merge into one another and spread over larger areas in a tightening manner. The papules may become bluish in color. Depigmentation of the affected skin areas is typical. The onset of tissue atrophy is also possible. In comparison to the related syphillis, no bone lesions occur in pinta. The cardiovascular system as well as the central nervous system are also usually not attacked by the pathogen.
Diagnosis and course of the disease
With the onset of infection, Pinta disease requires an incubation period of two to three weeks. The further course of the disease is divided into three phases:
- In the first phase, reddish nodules appear on the skin. These are still sharply demarcated from each other, slightly raised and little scaling. They are not prone to lump formation or decay.
- After five to ten months, the secondary lesion appears, also known as a pintid. This resembles the primary lesion and occurs predominantly on the extremities and trunk. These papules go into the deeper layers of the skin and show the typical onset of depigmentation or a bluish discoloration. There is also swelling of the lymph nodes. Only if the disease persists for several years, a third phase develops.
- Here, the epidermis – the upper layer of skin – thickens increasingly. This process is also called hyperkeratosis. Furthermore, the named pigmentation disorders intensify: these can show in an overpigmentation (hyperpigmentation) or mostly a strong loss of skin pigments (depigmentation).
The absence of pigment in the skin is reminiscent of the so-called white spot disease vitiligo, which is one of the autoimmune diseases. In very rare cases, Pinta disease can lead to cardiovascular late effects. The diagnosis can already be made visually in the contaminated areas. In early stages, the diagnosis is made by microscope or by serological examination. In the early stages it resembles frambosia or in the late stages vitiligo.The similarities to leprosy and psoriasis also make a clear diagnosis difficult. At the latest, when the blue coloration begins and the depigmentation becomes prominent, an assignment to pinta can be made.
Complications
Pinta can cause a number of complications. If the skin disease is left untreated for an extended period of time, the initially small papules increase in size and number and eventually merge. This leads to pain, itching and further discomfort. Sometimes there is tissue atrophy and scarring of the skin. Rarely, the cardiovascular and central nervous systems are also affected. If left untreated, it subsequently leads to swelling of the lymph nodes and subsequently to so-called hyperkeratosis, i.e. thickening of the upper skin layer. Accompanying pigmentary disorders such as a loss of skin pigment or hyperpigmentation occur. Possible late effects of pinta are cardiovascular problems such as cardiac arrhythmias, circulatory collapse or heart attack. Also, secondary diseases such as syphilis or ulcus molle may be favored. Complications can also occur during treatment of pinta. For example, side effects and interactions can occur during antibiotic therapy, which are often particularly intense due to the weakened immune system. Removal of the papules is associated with the formation of scars and immediately leads to severe bleeding, which often becomes infected and leads to the development of other skin diseases.
When should you go to the doctor?
If unusual skin changes occur after living in Mexico or any Central or South American country, a visit to the doctor is recommended. Pinta is a mostly chronic condition that requires prolonged treatment. Anyone who notices the above symptoms is best to consult their family doctor or dermatologist. Children, pregnant women, elderly people and people with immunodeficiency should immediately consult the doctor if the above symptoms appear. The general practitioner, a dermatologist or a specialist in tropical diseases is responsible. A severe course, which manifests itself among other things by conspicuously light or dark skin areas, must be immediately examined by a specialist. During the therapy, which is carried out with medication, the patient should always consult the responsible physician due to the high risk of side effects. If gastrointestinal complaints or infections occur, it may be necessary to switch to a different preparation. Affected individuals ideally create a complaint diary and keep a record of the course of the disease and associated symptoms.
Treatment and therapy
It took decades to localize the causative agent. Today, it is known that this chronic infectious disease is a bacterium that responds very well to antibiotic therapy. The treatment is similar to that used for Frambösie. In this case, a single dose of penicillin is usually administered. A rapid clinical cure is seen, especially in the early stages. In case of existing penicillin intolerance, alternative antibiotics – such as doxycycline – are available. After only 24 hours, those affected are no longer considered infectious. However, the atrophies and depigmentation existing in the late stage are irreversible. A serological cure is also impossible. Affected individuals carry the pathogen throughout their lives.
Outlook and prognosis
Pinta is a rare skin disease that offers a relatively poor prognosis. The skin condition is mostly chronic and can persist for years. In severe cases, affected individuals suffer from pinta for the rest of their lives and suffer various health losses as a result. The quality of life is limited, for example, by the severe itching and the conspicuous pigmentary disorders. The treatment also carries risks. In most cases, pinta is treated with benzylpenicillin, which can cause headaches, hair loss and other symptoms in patients. The outlook and prognosis is based on the severity of the disease. It is determined by an internist, who performs various examinations for this purpose and also considers the previous course of the disease. Life expectancy is not reduced by Pinta. However, concomitant diseases can lead to further health complaints that can reduce life expectancy. These include infections, for example, which can lead to blood poisoning under certain circumstances.The prospect of recovery is good if the condition is detected early, ideally within the incubation period of about three weeks. Then treatment is often possible before the condition develops into a chronic disease.
Prevention
The disease can be prevented primarily by following basic hygiene measures. Since it is a resistant bacterium that is transmitted exclusively through skin contact, one should avoid that direct contact. Furthermore, regular, thorough hand washing – which includes adherence to a contact time of the soaps and disinfectants used – is mandatory.
Aftercare
In most cases, direct follow-up measures for pinta are relatively limited. In this case, the affected person is primarily dependent on a quick and, above all, an early diagnosis of the disease, so that no further complications or complaints can occur. The earlier a doctor is consulted, the better the further course of the disease usually is, so that the affected person should consult a doctor at the first signs and symptoms. Most sufferers of Pinta are dependent on taking various medications that can alleviate and limit the symptoms. In doing so, the affected person should always pay attention to a correct dosage and also to a regular intake in order to alleviate the symptoms. When taking antibiotics, it should also be noted that they should not be taken together with alcohol. A doctor should always be consulted first if there is any uncertainty or if the side effects are severe. As a rule, Pinta does not require any further follow-up after treatment. The disease does not reduce the life expectancy of the patient, although it can break out again despite treatment.
What you can do yourself
If pinta is suspected, the primary care physician should be consulted first. Depending on the type and severity of the disease, a number of tips and home remedies can be used to accompany medical therapy to reduce symptoms and support the recovery process. First of all, the doctor will recommend strict personal hygiene. The affected areas must be carefully groomed and disinfected with a medical disinfectant. This will prevent further spread of the resistant bacterium. Regular and thorough hand washing is equally important. The growths should not be touched or scratched during the first few days. Patients must choose clothing that neither chafes nor sticks to the open areas. This is accompanied by general measures such as exercise, a healthy diet and sufficient sleep. If stress is avoided at the same time, the symptoms usually subside quickly. If these measures do not have any effect, a doctor must be consulted. It is possible that the illness is due to another cause, which must first be diagnosed. The physician can also give further tips and, if necessary, refer the patient to an alternative practitioner.