Scarlet fever

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Clinical Features

Red "strawberry tongue" in a patient with scarlet fever.
Culture positive strep pharyngitis with typical tonsillar exudate
Characteristic red cheeks and rash of scarlet fever.
Scarlet fever rash.
  • Prodrome of fever, sore throat, vomiting, abdominal pain followed by rash 1-2d later
  • Rash
    • Enanthem (rash involving mucous membrane)
      • Tonsils/pharynx are red and covered with exudate
      • Tongue may have initial exudate followed by erythema ("strawberry tongue)
      • Soft palate have bright-red spots
    • Exanthem
      • Begins 1-2days after onset of illness
      • Starts on neck, axillae, groin, spreads to trunk and extremities
      • Red, finely punctate, sandpaper feel
      • Pastia lines: linear petechial eruptions in antecubital/axilla
      • Desquamation follows

Differential Diagnosis

Pediatric Rash

Erythematous rash


  • Clinical diagnosis, based on history and physical exam


  • Treatment (to reduce rheumatic fever / nephritis)


  • Discharge

See Also