Characteristics of skin lesions in patients with tsutsugamushi disease

Objective To investigate the clinical characteristics of skin lesions of tsutsugamushi disease.Methods The skin lesions and clinical characteristics of 17 hospitalized patients with tsutsugamushi disease were analyzed. Results Of the patients, 88.2% (15/17) developed eschar and skin ulcer, 64.7% (11/17) had skin rashes. The patients often developed solitary, painless and nonpruritic eschar 4 to 10 days after the occurrence of fever, with indefinite locations and average diameter of 1.2 cm (range: 0.5 - 3.0 cm). The eschar was covered with a black and dry surface and surrounded by a ring-shaped erythematous halo, and usually shedded 5 to 9 days after the appearance with the formation of shallow ulcer. Superficial lymphadenectasis was observed near the eschar in 80% of the patients with eschar, and no eschar was observed at the first visit in 66.7% of the patients. Skin rashes mainly included nonpruritic congestive papules (45.5%) and maculopapular rashes (54.5%), and often subsided 2 to 5 days after emergence. Conclusions The skin lesions of tsutsugamushi disease include eschar and skin rashes. Eschar is an important characteristic and highly suggestive of this entity.