Describe the pigmentation changes seen with the treponematoses. - Secondary syphilis: Hypopigmented macules can be found on the neck, shoulders, upper chest, and axillae in patients with secondary syphilis (due to Treponema pallidum). The hypopigmented neck lesions have been termed the “necklace of Venus.”
- Pinta: Pinta is a chronic nonvenereal disease caused by T. carateum that is endemic in Central and South America. The primary lesion, at the site of inoculation, is a hypopigmented patch or plaque on the arm, leg, or torso. Secondary pinta lesions (pintides) are at first erythematous, then become hyper- and hypopigmented. Later in the disease, pinta lesions become more uniformly hypopigmented.
- Yaws: Yaws is a nonvenereal disease caused by T. pallidum subspecies pertenue that is common in children in impoverished, very warm, tropical areas of Africa. It may also be seen in Southeast Asia, the Pacific Islands, and tropical America. The primary lesion heals as an atrophic hypopigmented scar. Secondary yaws often heals without dyspigmentation, but the gummatous tertiary yaws lesions localized to the lower extremities, volar wrists, and dorsal hands are depigmented.
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