It is a endemic human skin disease caused by infection with a spirochete bacterium, Treponema pallidum carateum, which is morphologically indistinguishable from the spirochete that causes syphilis. It is the least severe of treponemal infections by being limited to the skin area and is thought to be transmitted by skin-to-skin contact. After an incubation period of two to three weeks, the pathogen produces a raised papule, which enlarges and becomes hyperkeratotic (scaly/flaky). Lesions are usually present in the exposed surface of arms and legs due to the enlargement of the Local lymph nodes, 3-9 months later, further thickened and flat lesions (pintids) appear all over the body. These generally resolve, but a proportion of people with pinta will go on to develop late-stage disease, characterised by widespread pigmentary change with a mixture of hyperpigmentation and depigmentation which can be disfiguring.