A maculopapular exanthema appears at the onset of fever or during the succeeding one to two days and quickly becomes vesicular. The vesicles are small and are located on top of a papular base, which is sometimes surrounded by erythema. They may be numerous or few and may involve all parts of the body but usually spare the palms and soles. The lesions are not pruritic. Within a week, the vesicles dry and crust over.
Healing occurs without scarring.
There is no clinical evidence of pulmonary or other visceral involvement. The disease with which rickettsialpox is most frequently confused is chickenpox. Chickenpox, however, is generally a childhood disease, whereas rickettsialpox most commonly occurs in adults. The eschar at the site of the primary lesion of rickettsialpox has no counterpart in chickenpox. As in all rickettsioses, therapy with a tetracycline or with chloramphenicol is effective.