Histopathology is nonspecific but suggestive, consisting of mild acanthosis, mild lymphocytic spongiosis, focal basal cell necrosis and a mild dermal infiltrate rich in plasma cells. Bony prominences may be disproportionately affected, especially on the legs. In the tertiary stage, symmetric pigmentary abnormalities appear, ranging from vitiligo-like depigmentation (most common) to variable areas of hyperpigmentation.
Areas of hypopigmentation may be admixed with areas of dark dyschromia (Figure 1). Initially erythematous individual papules and plaques change to brown, slate blue, black or gray color.(In some countries, affected individuals are called “morados”-the blue ones.) This stage appears 3-5 years after inoculation and waxes and wanes for 2-4 years. The latter is characterized by a generalized papulosquamous eruption. The lesion may resolve or persist into the next stage, secondary pinta. Primary pinta consists of a sentinal, fairly large (10 cm), nonpruritic scaly plaque, with a predilection for the lower extremities. Characteristic findings on physical examinationĪnalogous to syphilis, physical findings will depend upon the disease stage. Since this disease is unique among the treponematoses in causing only cutaneous disease, the patient should not give a history of constitutional symptoms or symptoms that suggest visceral involvement. During a very protracted course, typically amounting to one or two decades, the patient will have developed widespread psoriasiform lesions that eventuate in a dyschromic residual. Thus, it would be highly unlikely to encounter this disease unless the individual had prolonged residence in an endemic area. It is localized to the Western Hemisphere: Mexico, Central and South America and the Caribbean. Pinta is one of three endemic treponematoses. Are You Confident of the Diagnosis? What you should be alert for in the history
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