Scarlet fever occurs most often during the winter months. Children between the ages of three and 12 are the most susceptible. It is extremely contagious, spread by coughs and sneezes.
Scarlet fever comes on suddenly with a fever of 103°F (39.4°C) or higher, accompanied by a sore throat, physical weakness, headache, nausea, and stomachache. The high fever may cause convulsions.
Twelve to 48 hours after the onset of fever, a fine, rough rash (often likened to sandpaper or sunburn with goosebumps) appears in the armpits and groin and on the neck and inner thighs. It then spreads out to the chest, back, arms, and legs. The roof of the mouth may also break out, and the throat and tonsils appear bright red. The child's tongue is first covered with a white, fuzzy coating before changing to bright red. The rash lasts two to three days and then the skin begins to peel off in flakes, scales, and sheets. The face is usually the first to peel. The peeling lasts from three to eight weeks depending on the severity of the case.
The rash of scarlet fever is often confused with that of the measles (rubeola), German measles (rubella), toxic shock syndrome, heat rash, or sunburn. Therefore, the child should be seen by a physician on the first day that the rash breaks out. The doctor takes a throat culture to verify a strep infection and then prescribes an antibiotic. While the fever lasts, the child needs plenty of rest, fluids, and a fever-reducing medication. If left untreated, scarlet fever can lead to a middle-ear infection and/or abscess of the tonsils. In rare cases, the disease results in rheumatic fever and nephritis (inflammation of the kidneys).
Fry, John, and Gerald Sandier. Common Diseases: Their Nature, Prevalence, and Care. (5th ed.) Boston: Kluwer Academic Publishers, 1993.
Hamann, Barbara P. Disease: Identification, Prevention, and Control. St. Louis: Mosby, 1994.