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Scarlet Fever overview

Published: July 17, 2009. Updated: August 09, 2009

Scarlet fever consists of streptococcal infection, usually pharyngitis, accompanied by a characteristic rash. The rash arises from the effects of a group of toxins, currently designated streptococcal pyrogenic exotoxins and previously known as erythrogenic or scarlet fever toxins. Studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.

Clinical manifestations

The symptoms of scarlet fever are the same as those of pharyngitis alone. The rash typically begins on the first or second day of illness over the upper trunk, spreading to involve the extremities but sparing the palms and soles. The rash is made up of minute papules, giving a characteristic "sandpaper" feel to the skin.

Associated findings include circumoral pallor, "strawberry tongue" (enlarged papillae on a coated tongue, which later may become denuded), and accentuation of the rash in the skin folds (Pastia's lines) "raspberry tongue". Subsidence of the rash in 6 to 9 days is followed after several days by desquamation of the palms and soles.


The illness is spread by the same means as strep throat.


Treatment with gram positive antibiotics. Other than the occurrence of the rash, the treatment and course of scarlet fever are no different from those of any strep throat.

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