Scarlet fever rash


A distinctive symptom of scarlet fever is the noticeable rash that appears 1-3 days after infection with the bacterial pathogen Streptococcus pyogenes.
Pinhead-sized, red spots that rise slightly from the surface of the skin spread from the head and neck area over the trunk and extremities. The rash is particularly pronounced in the bends of the joints and the groin area.

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. Smallest hemorrhages in the top layers of the skin can also occur, they are called petechiae, but are not specific to scarlet fever.

You can find more about this at Scarlet fever rash, streptococcal rash


The rash comes from that Streptococcus pyogenes bacterium which has been infected by a viral bacteriophage and thus has the ability to produce a to produce erythrogenic toxin. This poison stimulates the body's own defense cells and thereby leads to a increased cytokine release. Cytokines act, among other things, on vessel walls and lead to one there Increase in permeability. This allows erythrocytes to escape from the vessels and the visible ones reddish rash the skin.


Scarlet fever is considered a visual diagnosis due to its conspicuous appearance. However, if the rash is weak or not at all, a blood count or throat swab can provide information about a possible bacterial infection.

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.

Find out more about the various Symptoms of scarlet fever.

accompanying symptoms

The symptoms accompanying the rash can be very diverse. The onset of the disease is very sudden. It often happens right after infection high fever and Sore throat (Scarlet Angina). paleness and Exhaustion complete the clinical picture until it finally occurs Rash comes. At this point it can also be nausea and Vomit, as well as to a purulent runny nose come.


Scarlet fever is a disease that does not cause itching. In contrast are diseases like measles or rubellawhere itching is a leading symptom. A red rash, on the other hand, is characteristic of all of these diseases.

also read Rash without itching

Duration of the rash

Usually the rash sounds after a week slowly from and accompanying symptoms, such as fever and sore throat, subside. Follow the reddening of the skin often flakingwhich are particularly evident on the palms of the hands and soles of the feet. These scaling can continue for some time, heal but by itself.

Therapy of the rash

When suffering from scarlet fever, a A doctor's visit is strongly recommended. If the disease is detected early, a Therapy with antibiotics Relieve symptoms and prevent possible long-term effects. Also the Risk of contagion is evident under antibiotic therapy reduced. Often a Ten days of penicillin prescribed that must be adhered to in spite of rapidly decreasing symptoms.

In addition, symptomatically oriented antipyretic drugse.g. Paracetamol, or Painkiller are 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.

A Vaccination against scarlet fever does not exist at the moment.

Differences between children and adults

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.

Read more on this topic: Scarlet Fever in Pregnancy

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: The scarlet tongue

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.

Scarlet fever without a rash

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:

  • Adult scarlet fever

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 the typical clinical picture does not appear, it is important to distinguish it from other diseases, but not to ignore it.

You might also be interested in: Complications of scarlet fever