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Contributors: Erin X. Wei MD, Edith Lederman MD, Susan Burgin MD
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Pinta, also known as azul, carate, and mal de pinto, is a nonvenereal endemic treponemal infection caused by the spirochete Treponema pallidum subsp carateum. The disease is confined to rural areas of northern South America and Mexico. However, current prevalence data is lacking.

Pinta affects all age groups, as opposed to other endemic treponemal diseases for which children are the most often affected. Most cases are limited to the skin. Infection usually is spread by person-to-person contact in endemic areas by direct skin or mucous membrane contact.

Pinta infection is divided into 3 stages. After an incubation period of 7-30 days, the primary infection begins as one or several small papules, usually on the exposed surfaces of the extremities. Papules are typically painless but may be pruritic. These primary lesions enlarge over the course of 3-9 months to form secondary lesions, including scaly, reddish papules and sometimes psoriasiform plaques (pintids or psoriasiform pintids). Regional lymph nodes may be enlarged and painless or inflamed. Primary and secondary lesions are extremely infectious. Over time, the color of the lesions changes from copper to slate blue, and they eventually appear white (either hypo- or depigmented) and either macular or atrophic, marking onset of the third stage. In this stage, hyperkeratosis of the palms and soles may also be seen, along with atrophic plaques. Late-stage tertiary lesions are no longer infectious. Regional lymphadenopathy may persist in this stage.


A67.9 – Pinta, unspecified

22064009 – Pinta

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Differential Diagnosis & Pitfalls

Differential diagnosis varies depending on the stage of disease:

Primary and secondary lesions:
  • Cutaneous leishmaniasis – the lesions are more inflammatory and crusted
  • Sporotrichosis – the lesions are associated with trauma and ascend the lymphatic chain
  • Yaws – nonvenereal treponemal infection with more papillomatous lesions
  • Cutaneous tuberculosis, including lupus vulgaris and tuberculosis verrucosa cutis
  • Chromoblastomycosis
  • Lobomycosis – presents with smooth keloidal or verrucoid nodules
  • Cryptococcosis – the lesions are typically umbilicated
  • Arthropod bite or sting
  • Atypical mycobacterial infection
  • Tick granuloma
  • Coccidioidomycosis
  • Talaromyces marneffei infection
  • Nodular basal cell carcinoma
  • Cutaneous squamous cell carcinoma
Tertiary lesions:
  • Vitiligo
  • Tinea versicolor
  • Discoid lupus erythematosus (DLE)
  • Chemical leukoderma
  • Postinflammatory hypopigmentation
  • Leprosy – lesions take many forms, can be hypopigmented, and are sometimes anesthetic
  • Onchocerciasis – nodules in the skin, scarring, sagging of the skin, and blindness
  • Inherited Palmoplantar keratoderma or other forms of acquired Palmoplantar keratoderma

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Last Reviewed:07/14/2021
Last Updated:07/18/2023
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A medical illustration showing key findings of Pinta (Primary Stage) : Mexico, South America, Symmetric extremities distribution, Thick scaly plaque, Pruritus, Cheeks
Clinical image of Pinta - imageId=2057099. Click to open in gallery.  caption: 'Depigmented macules and patches on the dorsal hands and fingers.'
Depigmented macules and patches on the dorsal hands and fingers.
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