What are the characteristics of a scarlet fever rash?

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Last updated: June 28, 2025View editorial policy

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From the Guidelines

A scarlet fever rash is characterized by a fine, red, sandpaper-like appearance, typically starting on the neck, underarm, groin, and chest, and spreading to the rest of the body within 1-2 days, as described in various studies, including those from the Centers for Disease Control and Prevention 1. The rash consists of tiny bumps that give the skin a rough texture when touched and usually blanches (turns white) when pressed. Some key features of the rash include:

  • A characteristic flushed appearance with pallor around the mouth (circumoral pallor)
  • A strawberry tongue (white coating with red bumps initially, followed by a bright red appearance)
  • Prominent skin creases in body folds (Pastia's lines), particularly in the armpits, elbows, and groin The rash typically lasts 3-5 days before fading and may be followed by skin peeling, especially on the fingertips, toes, and groin area. It is worth noting that the provided evidence from the Centers for Disease Control and Prevention 1 focuses on case definitions for infectious conditions under public health surveillance, but the description of the rash is consistent with the typical presentation of scarlet fever.

From the Research

Characteristics of Scarlet Fever Rash

The characteristics of a scarlet fever rash can be described as follows:

  • A distinctive macro-papular rash, usually in children 2
  • Exanthema, which is a skin eruption 3
  • Maculopapular rashes on arms, thighs, and abdomen, with erythroderma on the face, ears, neck, chest, and back 4
  • The rash can be atypical, with distribution on the dorsum of the hand and feet, only till the level of wrists and ankles joints 3
  • Desquamation on the face, ears, and trunk can occur after the rash 4

Distribution and Appearance

The rash can appear in various parts of the body, including:

  • Arms 4
  • Thighs 4
  • Abdomen 4
  • Face 4
  • Ears 4
  • Neck 4
  • Chest 4
  • Back 4
  • Dorsum of the hand and feet 3

Age Group Affected

Scarlet fever can affect people of any age group, although it is primarily a pediatric illness 3

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Scarlet fever: a guide for general practitioners.

London journal of primary care, 2017

Research

Staphylococcal scarlet fever associated with staphylococcal enterotoxin M in an elderly patient.

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 2019

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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