Pathophysiology of scarlet fever

The bacteria commonly infect the throat, causing [Sore Throat](/symptoms/sore-throat/), painful swallowing, and swollen neck glands. Toxins released by some strains can produce a red, sandpaper-like rash that often begins on the chest or neck and spreads. The face may look flushed while the area around the mouth remains paler. [Fever](/symptoms/fever/) and a coated or unusually red tongue can occur. The rash reflects the body's response to the toxin; it does not mean the infection is only in the skin. The illness is related to [Strep Throat](/conditions/strep-throat/), but not every strep infection causes scarlet fever.

Arrange assessment when a child or adult has a sore throat with fever and a spreading rough rash. A clinician may examine the throat and use a swab or other test. If [Antibiotic Treatment](/treatments/medical-management/antibiotic-treatment/) is prescribed, complete the course and use the advised dose of pain or fever medicine. Encourage fluids and soft foods, avoid sharing cups or utensils, and wash hands often. Ask when the person can return to school or work, since treatment and fever status affect contagiousness.

Seek urgent care for trouble breathing or swallowing, drooling, a muffled voice, severe dehydration, marked drowsiness, a rapidly worsening rash, or swelling of the face or neck. Emergency help is needed for collapse, blue lips, or sudden confusion. Contact a clinician promptly if symptoms worsen despite treatment or new joint, urine, or swelling problems appear after the infection.

Does the rash and throat examination fit scarlet fever? Is a throat test needed? How should medicines be given, and when is the person no longer likely to spread infection? Which later symptoms should I report?