Scarlet Fever (cont.)

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What are scarlet fever symptoms and signs?

Scarlet fever usually starts abruptly with a sore throat and fever. Headache, enlarged lymph nodes in the neck, and fatigue are common. Younger children may complain of abdominal pain or have vomiting. On examination, the throat is inflamed and there may be patches of yellow pus (exudates) on the back of the throat. Although most cases of scarlet fever start with a sore throat, a small proportion arises from streptococcal infection of a wound.

Within two days of onset, a rash begins to appear. The rash usually starts on the chest and trunk then spreads to the arms and legs. The rash does not usually appear on the palms or soles. The face may be flushed, except for a pale area around the lips (circumoral pallor). In places where there are skin creases such as elbows, the rash may cause deep red lines known as Pastia's lines. The typical rash is diffusely red and blanches when pressed, but there may be areas with small cherry-red dots known as "petechiae" that do not blanch. Petechiae may also be seen inside the mouth on the palate. When the rash is present, the skin has small bumps and may feel rough like sandpaper (see Figure 1).

Picture of scarlet fever rash
Figure 1: Picture of scarlet fever rash on arm; Source: CDC

After two to four days, the rash begins to fade. At this time, the skin may start to peel and flake (desquamation), looking like the aftermath of a bad sunburn. Desquamation is particularly noticeable on the face and hands.

In addition to the skin rash, the tongue initially appears to be coated with a white substance through which red papillae may be seen. This is called a "white strawberry tongue." After two to four days, the coating sloughs off, leaving a bright red tongue with red papillae, called the "red strawberry tongue."

Medically Reviewed by a Doctor on 12/20/2013

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