Scarlatina

Dear Lisa,

I was told by my daughter’s Doctor that she has Scarlatina. Is it normal for her rash to look worse and be itchy when she first gets out of the bathtub?

“Daughter with Scarlatina”

Dear “Daughter with Scarlatina”,

“Scarlatina” is a hypersensitivity skin rash that children develop in response to the erythrogenic toxins produced by an infection.(1) The Scarlatina rash is usually caused by Group A beta hemolytic Streptococcus (Strep). In some cases it may be caused by a Staphylococcus infection (Staph). (2) The rash typically appears as red, closely grouped fine papules (tiny bumps) which give a sandpapery feel. It appears 24 to 48 hours after infection with these organisms and lasts 4 to 10 days.(2) The rash first forms in the axillae, groin and neck and then becomes more generalized. (3) It tends to be more prominent in the folds of the skin, such as under a child’s arms. (1) Peeling or desquamation of the skin usually occurs when the rash fades, typically at the end of the first week.

Many parents and children do not notice the rash at all because it is such a fine appearing rash. Unless you look at it in a good light it may be difficult to see, especially in a darker skinned child. Like most rashes, it would be more noticeable when a child bathes. Usually a child first complains of a sore throat which typically brings them into the doctor’s office and then the rash is noticed. Sometimes a child complains that the Scarlatina rash itches which is not surprising because it is a hypersensitivity reaction. Although, itching is usually not the presenting symptom. Those children that complain of itching should be able to control their symptoms with the use of over the counter anti-histamines such as oral Diphenhydramine or Benadryl.

When the Scarlatina rash is caused by strep it usually is accompanied by a strawberry appearing tongue and circumoral pallor or a pale color around the mouth. When the Scarlatina rash is caused by a Staph infection, the rash is often painful and tender. (2) Positive results from a throat culture or culture from a skin lesion confirms the diagnosis of Scarlatina. The treatment includes antibiotic therapy. Sometimes a Scarlatiniform rash may be associated with enteroviral (viral) infections.(1)

If your child’s rash does not respond to over-the-counter antihistamines, increases in intensity, persists, or wakes her at night it would be a good idea to contact her Doctor. If the skin sloughs off prematurely (in only a few days), the rash appears like a burn or involves mucus membranes such as inside the mouth, the eyes or vagina you should also contact your daughter’s doctor. These symptoms may be a sign of the development of another condition.(4)

Hope your daughter is feeling better soon.

(1) Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc 1990:472-473.
(2) Graham M, Uphold C. Clinical Guidelines in Child Health. Gainsville, Florida: Barmarrae Books. 1994:180-183.
(3) Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1686.
(4)Galante R. Cure Worse Than the Disease. Consultant for Pediatricians. 2006. August:495.


Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Parents with Sick Kids