A scarlet fever infection typically results in a rash that is characteristic of the disease (exanthem). It usually takes about 48 hours for the rash to appear after the onset of the disease.
These are small, pinhead-sized, "knotty-spotted" red spots that stand out slightly from the surface of the skin. They occur mainly on the face, trunk, arms and legs and particularly strong in the groin.
If you stroke the exanthema, a white stripe briefly forms (demographism albus).
Also typical are reddening of the cheeks with pallor in the mouth area and an extreme red coloration of the tongue, also called raspberry or strawberry tongue.
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Smallest hemorrhages in the top layers of the skin can also occur, they are called petechiae, but are not specific to scarlet fever.
The rash typically doesn't itch and usually fades after 4-7 days.
After a few weeks, characteristic flaking occurs on the affected areas.
You can find more about this at Scarlet fever rash, streptococcal rash
The characteristic rash must be associated with scarlet fever. Infection with certain bacteria, so-called beta-hemolytic streptococci, is what causes the rash to develop.
The bacteria are transmitted by so-called droplet infections. This means that contact persons can easily become infected if an infected person coughs or sneezes.
In some cases, infection can also take place through contact with infected objects (smear infection).
The toxins that the bacteria produce in the body (bacterial exotoxins or superantigens) are responsible for the symptoms. These toxins are recognized by the immune system and the rash occurs as an external sign of activation of the immune system.
Since there are many subgroups of these poisons, a new outbreak of the disease with a rash can occur even after a previous infection.
This poison stimulates the body's own defense cells and thereby leads to increased cytokine release.
The so-called cytokines act, among other things, on vessel walls and lead to an increase in permeability there.
This can cause erythrocytes to leak out of the vessels and cause the visible reddish rash on the skin.
Scarlet fever is a so-called eye diagnosis.
The typical symptoms, including in particular the rash, are crucial for the diagnosis of the infection.
If the findings are uncertain, if the symptoms are not particularly pronounced, antigen detection can be carried out.
If the result is positive, the diagnosis can be confirmed with a quick test.
Bacterial cultures can also be set up, but these need some time until the diagnosis is established.
The Rumpel-Leed test is another diagnostic test used to detect scarlet fever infection. With the help of an inflated blood pressure cuff, blood is accumulated in the arm.
If there is an infection with the toxin-producing pathogen, the increased blood pressure in the arm, under the condition of the increased permeability of the vessels, leads to small hemorrhages in the skin.
These can be indicative of the diagnosis.
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In addition to the characteristic rash, there are typically other symptoms associated with scarlet fever. An abrupt start with a high fever and sore throat (scarlet fever angina) is particularly typical.
This can be accompanied by chills and a generally poor general condition.
Pallor and exhaustion complete the clinical picture until the rash finally appears.
Dehydration, headaches, a purulent runny nose, nausea and vomiting can also occur.
Also characteristic is a bad smelling halitosis and a whitish-gray coated or red “raspberry or strawberry tongue”.
After the rash has healed, flaking of the skin is often found on the affected areas.
Find out more about the various Symptoms of scarlet fever.
If a rash occurs, it is often not immediately clear which disease is causing it. The extent and quality of the symptom can often provide clarity.
For example, it is crucial whether the rash is itchy or not.
Typical of the rash that occurs in the context of scarlet fever is that there is no itching.
If there is pronounced itching of the rash, it should therefore be checked whether the diagnosis of scarlet fever is correct.
In some cases, the rash that accompanies the scarlet fever is still itchy. However, dry skin, allergic reactions or other diseases can also lead to itching that is not primarily related to scarlet fever.
In contrast, there are diseases such as measles or rubella, in which itching is a leading symptom.
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As part of the typical peeling of the skin after 2-4 weeks, accompanying itching can occur.
If the itching is in the foreground, a doctor should be consulted who, if necessary, can re-examine the diagnosis and confirm that it is scarlet fever. Treatment of the itching can either be achieved by taking certain medications or applying certain ointments.
also read Rash without itching
Treatment of the rash that appears in the context of scarlet fever is achieved by treating the disease itself.
Any infection with the bacteria that cause scarlet fever should be treated with an antibiotic.
The antibiotic penicillin is primarily used here.
Since there are some allergies to this group of antibacterial drugs, alternative antibiotics (clindamycin, erythromycin) can be administered in these cases.
The administration of antibiotics serves not only to combat the bacteria that are responsible for scarlet fever, but also to shorten the symptoms. The antibiotic is the only drug that can significantly affect the symptom of the rash.
In addition, symptomatically oriented antipyretic drugs, e.g. Paracetamol, or pain relievers may be given.
Even without antibiotic therapy, the disease usually leads to a complete cure with rest and care.
The duration of the illness is, however, a significantly longer period and the occurrence of late effects, such as rheumatic fever, or acute kidney infection, is more common.
If antibiotics are taken early, the majority of those affected are only contagious 24 hours after taking the first antibiotics. Without taking an antibiotic, both the course of the disease and the risk of infection increase.
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If the family has frequent and short-lived scarlet fever infections, family members or close contacts may receive prophylactic antibiotic treatment.
This is especially true if these people have severe previous kidney diseases or immunosuppression.
There is currently no vaccination against scarlet fever.
Typically, the rash will not be itchy during a scarlet fever infection.
In these cases, a soothing and moisturizing cream is beneficial for irritated skin, especially to protect the lower skin layer when it comes to the characteristic flaking and peeling of the skin.
Imiquimod cream can be applied to affected areas of the skin if itching is present.
In children with an itchy rash, care should be taken to prevent scars from scratching too hard, such as wearing gloves at night.
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Adults and children react very differently to infection with the scarlet fever pathogen Streptococcus pyogenes.
The disease occurs much more frequently in children and usually shows the typical symptoms, albeit in different degrees.
Adults often only experience flu-like symptoms.
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Fatigue, sore throat, fever, etc. are not necessarily associated with scarlet fever, but rather attributed to a cold.
Therefore, a visit to the doctor is often avoided and there is no diagnosis and specific treatment right at the onset of the disease.
However, even in adults during the course of the disease, the strawberry tongue often appears or the pathogen causes secondary diseases, such as an otitis media.
Most of the time, the diagnosis of scarlet fever is delayed.
Further information on the topic can be found here:
One reason why the disease shows a different course in adults than in children is, among other things, a certain (partial) immunity in the case of an infection that has already passed through in childhood.
However, since there are different pathogens that cause scarlet fever, this immunity is only specific for the pathogen known to the body and does not necessarily prevent a new disease.
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In adults, the typical course with the classic symptoms can certainly occur, but in adults a weakened or atypical course of scarlet fever is much more common. Because of this, there is a greater risk that the disease will be overlooked.
If the diagnosis of scarlet fever is not made due to mild symptoms, the patient is probably not receiving antibiotic therapy.
The risk of long-term effects or complications is therefore increased in adults.
Without antibiotic therapy and adequate physical rest, the actual infection can lead to post-streptococcal infection with fever, joint involvement, kidney involvement, skin rash - streptococci are the triggering bacteria of scarlet fever.
Find out more about the symptoms of scarlet fever in adults at:
In the therapy of scarlet fever, an antibiotic is taken, thereby reducing the number of bacteria and thus reducing the bacterial toxin. Of the However, the rash does not go away immediately. It takes a certain amount of time for the toxins to break down and for the reaction of the immune system to wane. Only then is there an improvement in the symptoms and an improvement in the skin reaction. Still that is Taking the right medication is essential for treating the condition and reducing symptoms. The Symptoms improvement is usually after 48 hours reached. That is important Taking the antibiotic for 10 days to achieve a definitive elimination of the bacteria.
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In rare cases, the antibiotic may not work or a penicillin allergy may result in a rash. Switching to another antibiotic will help cure the disease in both cases.
A rash that may occur after taking the antibiotic different causes underlie. If the antibiotic has only been taken for a short time and the disease has only existed for a few days, the immune system may react to the bacterial toxins still present in the body, although the number of bacteria is already reduced by taking the antibiotic.
In rare cases the antibiotic does not strike and the bacteria can continue to multiply despite ingestion and produce the toxins that cause the rash.
Became the The rash improved or even completely disappeared during therapy before the new rash appeared, there may be a Allergy to the drug ingested consists. Discontinuing the antibiotic should generally be discussed with a doctor. A reaction of the ingredients should also be considered when taking or applying other medications such as herbal ointments or the like.
If the Rash 2-4 weeks after the onset of the disease on, it is very likely to be a Peeling of the skinwhich can be understood as the normal and harmless reaction of the body to the disease.
The rash can generally appear all over the body. However, one of the typical sites of skin reaction is the face. Often the rash is first noticed on the face and, based on its typical location on the face, can provide the decisive clue for the presence of scarlet fever. It is noticeable that the rash is mostly on the cheeks while avoiding the area around the mouth. The connection with scarlet fever and this typical rash on the face is so characteristic of the disease that this constellation is referred to in medicine as a "Facies scarlatinosa".
A rash in the mouth is also very common. On the one hand, the soft palate is affected by the rash (localized in the mouth "above" and "behind"). In addition, a red tongue, which is also called "red raspberry or strawberry tongue" because of its appearance, is striking. As the rash progresses, it may spread to areas of the entire head and neck.
Further information on the topic can be found here: The scarlet tongue
The absence of the rash does not have to mean that it cannot be scarlet fever. Lately in particular, there have been an increasing number of atypical cases in which the rash is only weakly noticeable or not at all.
Read more on the subject at: Rash on the face
The skin on the abdomen is often affected by the rash that accompanies scarlet fever. The rash on the stomach occurs usually within 48 hours of the onset of the illness and can be assigned to the so-called exanthema stage (stage of the rash). However, it is noticeable that the rash is significantly lower on the stomach than on the groin, as well as under the armpits or on the cheeks. The rash on the stomach can be described as fine and "Knotty-spotty". It is also typical that the rash, just like on the rest of the body, changes from fine spots to diffuse reddening as the disease progresses.
For more information, see: Rash on the abdomen
After the onset of the disease, the rash spreads more or less all over the body, including the chest of the affected child. It is noticeable that the chest in contrast to the most severely affected areas, the groin and the bends of the joints as well as the face is less reddened and has fewer red dots. The finely spotted exanthema (Rash) turns into one after a while diffuse redness and disappears after the disease has healed.
Read more information on the topic at: Rash on the chest
The scarlet fever disease runs in characteristic stages. In addition to other symptoms, the location and duration of the rash are in the foreground for the correct diagnosis of the disease. At the onset of the disease, only the tongue is reddened and has what is known as "raspberry or strawberry tongue".
About 48 hours after the onset of the disease, a pale red, fine-spotted rash that can be described as "nodular-spotted" is noticed. This is particularly noticeable on the groin and cheeks and spreads over the entire body, somewhat weaker. After 1-2 days, the rash turns a bright red color and the fine spots turn into a diffuse reddening on the body.
The rash fades about 3-7 days after the disease starts. It is typical for the rash to subside just before the fever drops.
It should also be noted that scaling of the skin can occur after 2-4 weeks, which is understood as a consequence of the disease and the rash. In addition, there is often "glove-like" detachment of the skin on the palms and feet.
These flakes can persist for some time, but heal on their own.
It often happens that the disease is so mild that the rash associated with scarlet fever is completely overlooked.
Scarlet fever can occur even without the typical rash and raspberry tongue disease. This is particularly the case with adults.
You can also read the more detailed article on the clinical picture in adults at:
In this form, the disease must be differentiated from another bacterial infection or from an infection with Streptococcus pyogenes without the corresponding bacteriophage, which is responsible for the formation of toxins.
There are other symptoms (sore throat when the pharynx is colonized, etc.), but not vasomotor or inflammatory hyperemia, which is based on the formation of toxins and causes the reddening of the skin.
If scarlet fever is present without a rash or in a very mild form, the diagnosis can only be made by detecting the pathogen.
If the typical clinical picture does not appear, it is important to distinguish it from other diseases, but not to ignore it.
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