Scarlet fever physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Signs and symptoms

Early signs

• Flushed face with perioral pallor (circumoral pallor)
• Tachycardia (rapid pulse)
• Lymphadenopathy (enlarged lymph nodes)
• Punctate red macules on the hard and soft palate and uvula (ie, Forchheimer spots).
• Bright red tongue with a "strawberry" appearance

Rash

• Characteristic rash, which:

• is fine, red, and rough-textured; it blanches upon pressure
• appears 12–48 hours after the fever
• generally starts on the chest, axilla (armpits), and behind the ears
• is worse in the skin folds
• Pastia lines (where the rash becomes confluent in the arm pits and groins) appear and persist after the rash is gone

• The rash begins to fade three to four days after onset and desquamation (peeling) begins. "This phase begins with flakes peeling from the face. Peeling from the palms and around the fingers occurs about a week later and can last up to a month." Peeling also occurs in axilla, groin, and tips of the fingers and toes.

The "slapped cheeks" and "white mustache" of scarlet fever.

The scarlet fever rash.

Tongue with a strawberry appearance.