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Scarlet Fever

Strep Throat with a Rash

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Updated October 31, 2007

Scarlet fever is caused by certain strains of the group A streptococci bacteria (which also causes strep throat) and it is common to think of scarlet fever as strep throat with a rash. Symptoms usually develop about 1 to 7 days (incubation period) after being exposed to someone with strep throat or scarlet fever.

Scarlet fever is most common in children under 10 years old and begins with a fever and sore throat. Other symptoms can include vomiting, headache, chills and abdominal pain. Many children with this infection have a high fever initially, which may reach 103 to 104 degrees F. Without treatment, the fever may last 5 to 7 days, but usually quickly goes down within a day after starting antibiotic therapy.

After 12 to 48 hours of developing symptoms, your child will then develop a red rash, which consists of very small red bumps that begin on the neck and groin and then spreads to the rest of the body. The rash has the characteristic feel of sandpaper and typically lasts 5 to 6 days. The rash is sometimes worse on the neck, elbow creases, arm pits (axilla) and groin and once the rash fades, the skin may peel. This peeling may last up to 6 weeks.

Although the sandpapery rash does not usually occur on the face, your child's forehead and cheeks may appear red and flushed. In addition to this flushed appearance, there is usually a pale area around his mouth (circumoral pallor).

Another common finding is dark, hyperpigmented areas on the skin, especially in skin creases. These areas are called Pastia's lines.

The fever and rash is usually also accompanied by a red, swollen throat and tonsils that can have a white coating of pus, swollen glands, decreased appetite and energy level.

Another common finding is a red and swollen tongue. At first, the tongue usually also has a white coating on it, and with the red swollen papillae of the tongue protruding through this white coating, it gives the appearance of a strawberry tongue.

If scarlet fever is suspected in your child, your doctor will probably do a throat swab to confirm that there is infection with strep bacteria. This infection requires treatment with antibiotics, usually penicillin. Your child will no longer be contagious after being on an antibiotic for 24 hours. It is important to take a complete course of antibiotics to prevent your child from getting rheumatic fever.

Although not as common, scarlet fever can also follow a strep infection of the skin. Symptoms would be similar to the classic scarlet fever described above, but instead of a throat infection, there would be signs of a skin infection, especially around a burn or wound.

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