Differential Diagnosis for Sandpaper Rash

• Single most likely diagnosis
  • Scarlet fever: This is the most common cause of a sandpaper-like rash, typically accompanied by a high fever, sore throat, and strawberry tongue. The rash usually appears within 48 hours of the onset of fever.
• Other Likely diagnoses
  • Kawasaki disease: Although less common than scarlet fever, Kawasaki disease can also present with a rash that may feel like sandpaper, along with fever, conjunctivitis, and changes to the lips and tongue.
  • Allergic reactions: Certain allergic reactions, including those to medications or plants like poison ivy, can cause a rash that might be described as feeling like sandpaper due to its rough texture.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Toxic shock syndrome: This is a life-threatening condition that can cause a rash, fever, and other systemic symptoms. It's crucial to consider this diagnosis due to its high mortality rate if left untreated.
  • Staphylococcal scalded skin syndrome (SSSS): Caused by staphylococcal toxins, SSSS can lead to a rash and skin peeling, resembling a burn. It's more common in infants and young children but can be seen in adults with significant comorbidities.
• Rare diagnoses
  • Erythema marginatum: A rare manifestation of acute rheumatic fever, characterized by a rash that can feel like sandpaper and is often seen on the trunk and limbs.
  • Drug eruptions: Certain medications can cause a variety of skin reactions, including a sandpaper-like rash, though this is less common and would depend on the specific medication and individual reaction.