What are the key clinical features to consider when diagnosing scarlet fever in children?

Key clinical features for diagnosing scarlet fever in children include:

• A characteristic fine, sandpaper-like rash that typically starts on the chest and spreads to other parts of the body, sparing the area around the mouth (circumoral pallor) NICE CKS.
• Fever and sore throat are common initial symptoms, often accompanied by pharyngitis caused by Group A Streptococcus (GAS) infection Ferretti et al. 2016Ferretti et al. 2022 NICE CKS.
• The presence of a strawberry tongue—a red, bumpy tongue with prominent papillae—is a distinctive oral feature, often preceded by a white coating that peels off Ferretti et al. 2016Ferretti et al. 2022 NICE CKS.
• Pastia’s lines, which are linear petechial streaks in skin creases such as the antecubital fossa, may be observed NICE CKS.
• Flushed face with circumoral pallor is typical, along with pharyngeal erythema and sometimes tonsillar exudate NICE CKS.
• Cervical lymphadenopathy (enlarged, tender lymph nodes in the neck) is often present NICE CKS.
• Other systemic symptoms can include headache, nausea, and vomiting, reflecting the systemic nature of the GAS infection Ferretti et al. 2016 NICE CKS.

These clinical features usually appear 1-2 days after the onset of fever and sore throat. The rash typically fades after about a week, often followed by desquamation (peeling) of the skin, especially on the fingers and toes NICE CKS.

It is important to differentiate scarlet fever from other febrile illnesses with rash in children, such as Kawasaki disease, which may share features like strawberry tongue and rash but has additional signs like bilateral conjunctival injection and extremity changes NICE NG143,NICE CKS.

Prompt recognition of these key features supports early diagnosis and initiation of antibiotic treatment to reduce complications and transmission NICE CKS.