Differential Diagnosis for Sandpaper Rash

• Single most likely diagnosis
  • Scarlet fever: This is the most likely diagnosis for a sandpaper rash, as it is a classic symptom of the disease, caused by group A beta-hemolytic streptococcal infection. The rash typically appears 1-2 days after the onset of fever and sore throat.
• Other Likely diagnoses
  • Kawasaki disease: Although less common, Kawasaki disease can also present with a sandpaper-like rash, along with fever, conjunctivitis, and lymphadenopathy. It is an important consideration in children.
  • Toxic shock syndrome: This condition, caused by bacterial toxins, can lead to a rash that may resemble sandpaper, along with fever, hypotension, and multi-organ involvement.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Staphylococcal scalded skin syndrome (SSSS): Although rare, SSSS is a life-threatening condition caused by staphylococcal toxins that can lead to a sandpaper-like rash, along with widespread skin exfoliation and systemic symptoms.
  • Streptococcal toxic shock syndrome: This is a severe and potentially life-threatening condition that can present with a sandpaper rash, along with fever, hypotension, and multi-organ failure.
• Rare diagnoses
  • Erythema infectiosum: Caused by parvovirus B19, this condition can lead to a rash that may resemble sandpaper, although it is typically milder and more transient than the rash seen in scarlet fever.
  • Drug reactions: Certain medications can cause a sandpaper-like rash, although this is relatively rare and would typically be accompanied by other symptoms such as fever and eosinophilia.