What are the symptoms of scarlet fever?

Symptoms of Scarlet Fever

The classic symptoms of scarlet fever include high fever, sore throat, a characteristic sandpaper-like rash, and a "strawberry tongue" with prominent papillae. 1, 2

Key Clinical Features

Cardinal Symptoms

• Fever: Typically high (39°C/102°F or higher), with sudden onset 2, 3
• Sore throat: Often severe with pain on swallowing 4, 5
• Characteristic rash: Appears within 1-2 days after fever onset 2
  • Sandpaper-like, diffuse maculopapular eruption 3
  • Usually begins on neck, chest, and in skin folds, then spreads to trunk and extremities 3
  • Often more pronounced in skin folds (Pastia's lines) 2
  • May have accentuation in the perineal region 4
• "Strawberry tongue": Initially white-coated then bright red with prominent papillae 1, 2

Additional Common Findings

• Tonsillopharyngeal erythema with or without exudates 4, 6
• Tender, enlarged anterior cervical lymph nodes 4, 3
• Palatal petechiae 4
• Flushed face with circumoral pallor (pale area around the mouth) 2
• Headache, nausea, vomiting, and abdominal pain (especially in children) 4, 3

Disease Progression

Early Phase (Days 1-2)

• Fever and sore throat appear first 5
• Flushed face with circumoral pallor 2
• White-coated tongue that later becomes red 1

Middle Phase (Days 2-4)

• Characteristic rash appears, typically 1-2 days after fever onset 2, 3
• Rash feels rough like sandpaper 3
• "Strawberry tongue" becomes more prominent 1

Late Phase (Week 1-3)

• Desquamation (peeling) of skin, especially on fingertips, toes, palms, and soles 2
• This typically begins 1-3 weeks after the initial infection 3

Distinguishing Features from Similar Conditions

• Unlike viral rashes, scarlet fever rash feels rough to touch (sandpaper-like) 3, 6
• Unlike Kawasaki disease, scarlet fever typically has exudative pharyngitis and responds rapidly to antibiotics 4
• Unlike viral pharyngitis, scarlet fever rarely presents with cough, hoarseness, or conjunctivitis 4
• Unlike Rocky Mountain Spotted Fever, scarlet fever rash rarely becomes petechial and typically appears earlier in the course of illness 4

Atypical Presentations

• In some cases, the rash may be limited to specific areas such as the dorsum of hands and feet 6
• The rash may be less prominent or absent in some patients 6
• Adults may present with milder symptoms than children 6

Complications if Untreated

• Local complications: Peritonsillar or retropharyngeal abscess, otitis media, sinusitis 2, 3
• Systemic complications: Acute rheumatic fever, glomerulonephritis, endocarditis, meningitis 2, 3

Key Diagnostic Considerations

• Scarlet fever is most common in children aged 5-15 years 4, 3
• It typically occurs in winter and early spring in temperate climates 4
• Diagnosis is confirmed by throat culture or rapid antigen detection test positive for Group A Streptococcus 5
• Early antibiotic treatment is essential to prevent complications and reduce transmission 5, 3

Remember that prompt recognition of scarlet fever symptoms is crucial for early treatment, which can significantly reduce the risk of complications and prevent spread of this highly contagious disease 2, 5.