By Gary M. White, MD
Sandpaper rash in a child.
The rash of scarlet fever is caused by a toxin-producing group A beta hemolytic Streptococcus. The tonsil or pharynx is the usual site of infection but surgical wounds or other foci are possible. A rapid antigen detection test may be performed, but it has a significant false positive rate and negative tests should be backed up by culture.
A child typically 4-8 years of age will develop a high fever, sore throat, headache and vomiting. The exanthem follows within 1-2 days and appears as many small papules on diffuse erythema. The skin may feel rough like sand paper. Linear petechie in the axilla and groin--Pastia's lines--are classic as is circumoral palor. Desquamation worse on the hands and feet begins 7-10 days later. The tongue may be initially white and later red (strawberry tongue).
Penicillin orally or IM is effective. Erythromycin may be used in PCN-allergic patients. Recurrent attacks of scarlet fever may occur.
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