II. Pathophysiology
- Occurs in Group A beta-hemolytic streptococcal (GAS) infection (typically Streptococcal Pharyngitis)
- Some GAS strains produce streptococcal pyrogenic exotoxin
- Patients with Hypersensitivity to the toxin may develop a rash
III. Epidemiology
- May occur in up to 10% of Streptococcal Pharyngitis cases
IV. Symptoms
-
Fever
- Peaks on Day 2
- Returns to normal on Day 5-7
- Chills
- Headache
- Vomiting
- Pharyngitis
V. Signs
- Forehead and cheeks appear flushed
- Circumoral pallor and sparing of rash
- Pharyngitis
- Strawberry Tongue
- Sandpaper Rash (Scarlatiniform Rash)
- Onset with 12-72 hours after fever
- Coalescing, blanching erythematous Macules (may appear Sunburn-like)
- Fine papular or punctate lesions
- Texture of coarse sandpaper
- Rash distribution
- Starts on upper trunk
- Rash distribution generalizes within 24 hours
- Rash may affect flexor creases (Pastia lines) in the axillae, antecubital, groin and neck
- Pastia lines do not typically blanche
- Rash spares the palms and soles
- However, Desquamation of palms and soles may occur
-
Desquamation
- Follows rash fading after several weeks
- Desquamation of face, skin folds, hands and feet
- Desquamation may last up to 6 weeks
VI. Labs
- Streptococcal Rapid Antigen Test
-
Throat Culture
- Used to confirm a negative rapid Antigen test
- Antistreptolysin O titer (ASO Titer)
- Confirms diagnosis, but not typically helpful in acute disease
VII. Differential Diagnosis
- Staphylococcal Scalded Skin Syndrome
-
Kawasaki's Disease
- Also with Desquamation of palms and soles as well as strawberry Tongue
VIII. Management
- See Group A Streptococcal Pharyngitis for management
IX. References
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Related Studies
| Definition (NCI) | A streptococcal infection, mainly occuring among children, that is characterized by a red skin rash, sore throat, and fever. |
| Definition (MSH) | Infection with group A streptococci that is characterized by tonsillitis and pharyngitis. An erythematous rash is commonly present. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D012541 |
| ICD9 | 034.1 |
| ICD10 | A38 , A38.9 |
| SnomedCT | 154303009, 30242009 |
| LNC | LA17017-7 |
| English | Fevers, Scarlet, Scarlet Fever, Scarlet Fevers, Fever, Scarlet, scarlet fever, scarlet fever (diagnosis), Scarletina, Scarlet fever, NOS, Scarlet Fever [Disease/Finding], Scarlatina, Scarlet fever, Scarlet fever (disorder), febris; rubra, rubra; febris, scarlatina |
| Spanish | escarlatina, escarlatina (trastorno), fiebre escarlata (trastorno), fiebre escarlata, Fiebre Escarlata, Fiebre escarlatina, Escarlatina |
| Dutch | scarlatina, scarlatine, febris; rubra, rubra; febris, roodvonk, Roodvonk, Scarlatina |
| Japanese | 猩紅熱, ｼｮｳｺｳﾈﾂ |
| Swedish | Scharlakansfeber |
| Czech | spála, Spála, druhá dětská nemoc, scarlatina |
| Finnish | Tulirokko |
| Russian | SKARLATINA, СКАРЛАТИНА |
| Korean | 성홍열 |
| Polish | Płonica, Szkarlatyna |
| Hungarian | Skarlátos láz, skarlát, Scarlatina |
| Norwegian | Skarlagensfeber, Scarlatina |
| Portuguese | Febre Escarlate, Escarlatina |
| French | Scarlatine |
| German | Scarlatina, Scharlach |
| Italian | Scarlattina |
