Clinical Reference Systems: Pediatric Advisor 10.0
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DESCRIPTION (Diagnosis must be confirmed by a physician.)

• Reddened, sunburned-looking skin (especially on the chest and abdomen) that feels rough, somewhat like sandpaper.
• On close inspection, the redness is speckled (tiny pink dots).
• Increased redness in skin folds (especially the groin, armpits, and elbow creases).
• The rash covers all areas within 24 hours.
• Flushed face with paleness around the mouth.
• Sore throat and fever (usually occurring 18 to 24 hours before the rash).

CAUSE

Scarlet fever is a strep throat infection with a rash. The complication rate is no different than the complication rate for strep throat alone. The rash is caused by a toxin that is produced by some strep bacteria.

EXPECTED COURSE

The red rash usually clears in 4 or 5 days. Sometimes the skin peels in 1 to 2 weeks where the rash was most prominent (for example, the groin). The skin on the fingertips also commonly peels. Your child will stop having a sore throat and fever after taking an antibiotic for 1 or 2 days.

HOME TREATMENT

1. Antibiotics

   Your child needs the antibiotic prescribed by your physician.

   Try not to forget any of the doses. If your child goes to school or a baby sitter, arrange for someone to give the midafternoon dose. Give the medicine until all the pills are gone or the bottle is empty. Even though your child will feel better in a few days, give the antibiotic for 10 days to keep the strep throat from flaring up again.

   If the medicine is a liquid, store it in the refrigerator. Use a measuring spoon to be sure that you give the right amount.

   A long-acting penicillin (Bicillin) injection can be given if your child will not take oral medicines or if it will be impossible for you to give the medicine regularly. (Note: If given correctly, the oral antibiotic works just as rapidly and effectively as a shot.)

2. Relief of sore throat

   Acetaminophen or ibuprofen is very helpful. Children over 1 year old can sip warm chicken broth or apple juice. Children over 4 years old can suck on hard candy or lollipops.

3. The rash

   The rash itself needs no treatment. It generally clears in 4 to 5 days.

4. Contagiousness

   Your child is no longer contagious after he or she has been on an antibiotic for 24 hours. Therefore, your child can return to school after 1 day if he or she is feeling better. The rash itself is not contagious.

5. Throat cultures for the family

   Scarlet fever and strep throat can spread to others in the family. Any child or adult who lives in your home and has a fever, sore throat, runny nose, headache, vomiting, or sores; or who doesn't want to eat; or who develops these symptoms in the next 5 days should have a throat culture. In most homes your physician needs to culture only those who are sick. (EXCEPTION: In families where relatives have had rheumatic fever or frequent strep infections, everyone should come in for a throat culture.) Your physician will call you if any of the cultures are positive for strep.

6. Recurrent strep throat and recultures

   Usually repeat throat cultures are not necessary if your child takes all of the antibiotic. However, about 10% of children with strep throat don't respond to initial antibiotic treatment. Therefore, if your child continues to have a sore throat or mild fever after treatment is completed, return for a second throat culture. If it is positive, your child will be retreated with a different antibiotic.

CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:

• Your child starts acting very sick.

CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS IF:

• The fever lasts over 48 hours after your child starts taking the antibiotic.
• You have other concerns or questions.