What are characteristics of the maculopapular rash in Rocky Mountain spotted fever (RMSF)?

Updated: Mar 23, 2021
  • Author: Sunny Patel, DO; Chief Editor: Michael Stuart Bronze, MD  more...
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In 88-90% of RMSF cases, the maculopapular rash appears 2-6 days after onset of fever and progresses through stages and distribution that are never pathognomonic. The rash begins as a maculopapular eruption on the wrists and ankles and spreads centripetally to involve the trunk and extremities.

Classic distribution of RMSF rash on the palms and soles occurs relatively late in the course, appearing in 43% of patients only after the fifth day of symptoms. (The hands and the feet are both involved 49-74% of the time.) Some reports have documented 36-80% of patients with RMSF lack the classic distribution of rash on the palms and soles.

The face is usually spared. Involvement of the scrotum or the vulva is a diagnostic clue. Nonproductive cough may accompany the rash (33%).

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