Clinical Manifestations and Pathology

There is no chancre, and the condition begins as an extragenital papule, usually situated in the lower extremity (and perhaps associated with damage to the skin surface). Within 3 weeks, the papule has expanded into a reactive patch of circinate form, termed a pintid. In the next few months, a more general rash occurs on the face and limbs, which can be similar in appearance to such diseases as psoriasis, ringworm, and eczema.

Histologically, hyperkeratosis and intercellular edema are evident, with an increase of lymphocytes and plasma cells. In adults, there are usually pigmentary changes in the later stages. Bluish patches are perhaps most characteristic, but lesions may be white. Pigmentary function is clearly disturbed, and in the white patches pigment is absent. It should be emphasized that other treponematoses can start out to some extent like pinta, but that the others progress beyond purely skin changes. The disease is not transmitted to the fetus.

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