Scarlet Fever - Quick Bites Internal medicine ( Infectious diseases )

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Scarlet fever — Scarlet fever (also known as "scarlatina") is a diffuse erythematous eruption that generally occurs in association with pharyngitis. Development of the scarlet fever rash requires prior exposure to S. pyogenes and occurs as a result of delayed-type skin reactivity to pyrogenic exotoxin (erythrogenic toxin, usually types A, B, or C) produced by the organism.

The rash of scarlet fever is a diffuse erythema that blanches with pressure, with numerous small (1 to 2 mm) papular elevations, giving a "sandpaper" quality to the skin. It usually starts in the groin and armpits and is accompanied by circumoral pallor and a strawberry tongue. Subsequently, the rash expands rapidly to cover the trunk, followed by the extremities, and, ultimately, desquamates; the palms and soles are usually spared. The rash is most marked in the skin folds of the inguinal, axillary, antecubital, and abdominal areas and about pressure points. It often exhibits a linear petechial character in the antecubital fossae and axillary folds, known as Pastia's lines.

The diagnosis is established based on clinical manifestations. Apart from rapid strep testing and throat culture, there is no role for additional testing.

Scarlet fever with pharyngitis can predispose to acute rheumatic fever. The approach to treatment of scarlet fever is the same as that of streptococcal pharyngitis; no additional treatment is warranted for the skin rash. Children may return to school or daycare 24 hours after initiation of antibiotics. No additional monitoring for such patients is required.

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