clinical features

Last reviewed 06/2022

  • typically the first symptoms of scarlet fever develops after an incubation period of 2 to 4 days and includes:
    • tonsillitis
    • fever (usually above 38.3º C/101º F or higher)
    • headache, malaise, nausea and vomiting (1)
  • characteristic fine red rash
    • develops twelve to forty eight hours after the onset of these symptoms
    • first appears on the chest and stomach and later covers the entire body and limbs and consists of many small papules on diffuse erythema that blanches on pressure (1,2)
    • often more marked over the skinfolds where transverse lines containing tiny petichae may be seen
    • area around the mouth is spared
    • the skin may feel rough like sandpaper
    • the rash lasts for a period of two to three days, after which desquamation occurs that is most prominent on the soles of the feet and the palms of the hands (1)
  • examination of the throat generally reveals that the pharynx is diffusely reddened, with enlarged and red tonsils covered with a white exudate. The tongue may be initially furred with enlarged papillae - an appearance described as a 'white strawberry t     ongue', lost after two or three days to become strawberry tongue.
  • usually there is enlargement of regional lymph nodes (1)
  • flushed red face with paleness around the mouth (1)
  • note that although, in general the tonsil or pharynx is the site of infection, occasionally other foci e.g. surgical wounds may occur