What are the skin findings in American trypanosomiasis?

American trypanosomiasis, or Chagas’ disease, is caused by the parasite Trypanosoma cruzi, which is introduced through the conjunctiva or skin following the bite of blood-sucking reduviid bugs (kissing bugs). This insect has the disgusting habit of defecating on the skin following its human blood meal, and the infected feces are inoculated into the conjunctiva or wound. A unilateral conjunctivitis and lid edema (Romana’s sign) are usually the first clinical signs. Later, the patient may become systemically ill with various rashes and subcutaneous nodules, as well as cardiac and gastrointestinal lesions that may be fatal.