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
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