Scarlet Fever (cont.)
Scarlet Fever Symptoms and Signs
The symptoms and signs of scarlet fever usually begin one to four days after exposure to the streptococcal infection (incubation period). As previously mentioned, scarlet fever typically occurs in association with a pharyngeal streptococcal infection, therefore many of the symptoms and signs initially will be similar to that of strep throat and may include any of the following:
- Sore throat
- The throat may appear reddened and swollen, and there may be white patches on the tonsils or on the back of the throat (tonsillar exudate).
- Abdominal pain
- Swollen and tender lymph nodes on the sides of the neck (cervical lymphadenopathy)
Approximately one to four days after the onset of illness, a characteristic skin rash will appear with the following properties.
- The rash typically begins on the chest, neck, and armpit area and then spreads to other areas of the body.
- The rash is often more pronounced and reddened in areas of skin creases, such as the axilla, the neck, the inguinal area, and in the creases of the elbow (antecubital fossa) and the knee (popliteal fossa). Ruptured capillaries in these areas may cause the resultant rash to appear as lines (termed Pastia lines).
- The rash is described as fine and rough-textured (like sandpaper), consisting of multiple red punctate lesions. The rash blanches when pressed upon.
- The face may appear flushed, and the area around the mouth may appear pale (circumoral pallor).
- The rash may last anywhere between two to seven days. After the rash has faded, the skin begins to peel (desquamation), and this may last up to several weeks. The extent and duration of skin peeling is directly related to the initial severity of the rash. Areas commonly affected include the fingers, toes, palms, axilla, and the groin.
- During the first one to two days of illness, the tongue may have a white-colored coating with protruding, swollen, and red papillae on the surface. After about four to five days, the white coating sloughs off revealing a red-colored tongue with prominent papillae (strawberry tongue).
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