Cutaneous manifestations of scrub typhus: a comprehensive review of diagnostic clues in a neglected tropical disease.

Scrub typhus, caused by Orientia tsutsugamushi, is a re-emerging zoonotic infection with significant diagnostic reliance on its cutaneous manifestations. The disease, transmitted by larval trombiculid mites, is endemic to the 'Tsutsugamushi Triangle' and extends to other regions globally. Dermatological features are pivotal in early recognition, with eschar formation being pathognomonic. Eschars, resembling 'cigarette burns', develop as necrotic lesions surrounded by erythema and often resolve with minimal scarring. Maculopapular rashes, although variably reported, predominantly affect the trunk and upper extremities. Vascular complications like leucocytoclastic vasculitis and rare presentations, including gangrene and IgA vasculitis (Henoch-Schönlein purpura) highlight the spectrum of skin involvement. While systemic features like fever and lymphadenopathy guide the clinical picture, recognizing cutaneous signs is crucial for timely diagnosis, especially in resource-limited settings. This review emphasizes the dermatological spectrum of scrub typhus, aiding clinicians in differentiating it from other eschar-associated conditions.