Typical cutaneous manifestations of SFGR include a discrete maculapapular rash which usually appears towards the end of the first week of illness and involves the trunk, limbs, palms and soles, however spares the face. The rash tends to be more prominent at the time the patient is having fever and fades in between fever spikes. Other rare forms of skin rash have been described, and involve a dusky erythematous hue, distributed mainly on the limbs, back of the chest, anterior abdomen and soles . Severe rashes associated with SFG rickettsioses include digital gangrene and extensive skin necrosis described as PF [9–11]. While the digital gangrene may result in auto-amputation of toes , the skin involvement in PF results in blackish discoloration of skin that desiccates and peels off with complete recovery or hypertrophic scar formation after healing .