In the later stages haemorrhages into the skin (petechiae) are common.
Trypanosomiasis.—Patchy areas of erythema are often noted in Europeans affected with this disease. These are frequently circinate with fading in the center and tend to appear on the trunk.
In natives a dry skin is more often noted.
Rat Bite Disease.—An eruption of purplish spots may accompany the fever. There is a resemblance to erythema multiforme.
Dengue.—The true eruption of dengue is the one that appears about the fourth or fifth day as a measles-like eruption, starting about wrists or ankles.
Kala-azar.—There is a darkening of the colored skin of the natives suffering from this disease and it is to this feature that the disease owes its name.
In Europeans the appearance is more that one sees in old malarial cachectics, an earthy gray color. The characteristics of cutaneous leishmaniasis are discussed under that heading.
Typhus Fever.—Gangrene is particularly a feature of spotted fever of the Rocky Mountains and typhus fever, chiefly of the scrotum and prepuce with the former and of the extremities in the latter.
The distinctions of the eruptions of these two diseases and of tsutsugamushi are given on [page 445].
Tsutsugamushi.—A small necrotic ulcer with a dusky red areola, often located in the armpits or region of the genitals, marks the site of the bite of the infecting mite. From it a lymphangitis leads to the swollen glands. About the seventh day a macular eruption, which never becomes petechial, appears on face, then on trunk and extremities.