Scarlet fever

Background

• Caused by pyrogenic exotoxins (erythrogenic toxins) released by Streptococcus pyogenes that can be associated with potentially any streptococcal infection

Clinical Manifestation

• Most commonly associated with streptococcal pharyngitis, with fever, malaise, and a sore throat
• Rash appears on day 1 or 2 of illness, starting from trunk spreading to extremities
  • Appears as a diffuse erythema or erythroderma
  • Blanchable, with sandpaper texture
  • Flushed face with circumoral pallor
• White strawberry tongue early in disease gives way to beefy red strawberry tongue later
• May have petechiae starting 1 to 3 days after the rash, forming in the skin creases along Pastia lines

Management

• Treated with a 10-day course of penicillin (or clindamycin, if penicillin-allergy)