PINTA 



2099 



leucoder ma-like areas due to the disturbing action of the various 

 fungi on the pigmentation processes of the skin. 



Montoya's belief on the nature of white pinta in some cases is supported 

 by Castellani's observations on tinea fiava and tinea alba. In both these 

 dermatomycoses white, pseudo-leucodermic patches may occasionally be seen 

 long after the fungus has died out, and these patches may remain unpig- 

 mented for months and years. 



Mixed Variety. — Not infrequently the same patient may be 

 affected with several varieties of pinta, presenting a grotesque 

 tattooed or piebald appearance. 



It is especially white pinta which is found associated with one 

 or more of the other varieties. 



Diagnosis. — ^This does not present any difficulty in the countries 

 where the disease is endemic. In any doubtful case the micro- 

 scopical examination, supplemented when necessary by the use of 

 cultural methods, will clear the diagnosis. 



Differential Diagnosis — Tinea nigra. — In contrast to the black 

 variety of pinta, tinea nigra is very superficial, does not extend to 

 large portions of the body, may attack the palms of the hands, is 

 not pruriginous, is easily cured except when affecting the palms. 

 The microscopical examination of scrapings from patches of tinea 

 nigra will show mycelial tubes of irregular shape and large globular 

 spores collected in bunches. The spores are grouped together in a 

 somewhat similar manner to what one sees in pityriasis versicolor. 



Tinea Flava. — In contrast to yellow pinta, the fungus of tinea 

 fiava is a Malassezia, has the same morphological characters of the 

 fungus found in pityriasis versicolor, and cannot be grown arti- 

 ficially. 



Tinea Albigena and Tinea Alba. — These are generalized tricho- 

 phytic and epidermophytic affections, and are easily distinguished 

 by the characters of the fungi. 



Leprosy can be distinguished from white pinta lesions by the 

 sensibility not being impaired in pinta. 



Only white pinta patches with no fungus might be mistaken for 

 leucoderma on superficial examination. White pinta is very often 

 associated with other varieties of pinta, which are easily diagnosed. 

 Leucodermic patches are smooth, non-pruriginous, and the skin 

 surrounding them is often hyperpigmented. 



Prognosis. — Pinta, though not a fatal disease, must be considered 

 a serious affection, as its cours. is chronic and the treatment very 

 difficult. In most cases the general health remains satisfactory, 

 but the disfigurement is very distressing to the patients, who often 

 become nervous and irritable. The pruritus, which is generally 

 more marked at night, is also a cause of great distress and sleep- 

 lessness. 



Treatment. — ^Tbe popular treatment in Columbia is citrine oint- 

 ment (mercury nitrate ointment). Other parasiticides have been 

 tried, with a varying degree of success. When the eruption is at 

 the very beginning, tincture of iodine may suffice. The best results 



