In addition to the characteristic rash, scarlet fever typically causes other symptoms. An abrupt onset with high fever and sore throat (scarlet angina) is particularly typical. This can be accompanied by chills and a generally reduced general condition.
Paleness and exhaustion complete the clinical picture until the rash finally appears. Dehydration, headaches, a purulent rhinitis, nausea and vomiting can also occur. Also characteristic is a bad-smelling bad breath and a whitish-grey or red “raspberry or strawberry tongue“. After the rash has healed, skin scaling of the affected areas is often observed.
If a rash occurs, it is often not immediately clear which disease is causing it. The spread and quality of the symptom can often provide clarity. For example, it is decisive whether the rash itches or not.
Typical of the rash that occurs with scarlet fever is that there is no itching. If the rash is markedly itchy, it is therefore important to check whether the diagnosis of scarlet fever is correct. In some cases, the rash that accompanies scarlet fever may still itch.
However, it is also possible that dry skin, an allergic reaction or other illnesses may cause itching that is not primarily related to scarlet fever. In contrast, diseases such as measles or rubella, for which itching is a leading symptom, are also possible. Within the scope of the typical desquamation of the skin after 2-4 weeks, an accompanying itching can occur. If itching is the main symptom, a doctor should be consulted, who can check the diagnosis again if necessary and confirm that it is scarlet fever. Treatment of itching can be achieved either by taking certain medications or by applying certain ointments.
The treatment of the rash occurring in the scarlet fever is achieved by treating the disease itself. Any infection with the bacteria that cause scarlet fever should be treated with an antibiotic. Primarily the antibiotic penicillin is used here.
Since some people are allergic to this group of antibacterial drugs, alternative antibiotics (clindamycin, erythromycin) can be administered in these cases. The administration of antibiotics serves not only to combat the bacteria responsible for scarlet fever but also to shorten the symptoms. The antibiotic is the only drug that can significantly influence the symptom of the rash.
In addition, symptomatically oriented antipyretic drugs, e.g. paracetamol, or painkillers can be given. Even without antibiotic therapy, the disease usually leads to complete healing with rest and protection. However, the duration of the disease is much longer and the occurrence of late effects, such as rheumatic fever or acute kidney inflammation, is more frequent.
If antibiotics are taken at an early stage, the majority of those affected are contagious only 24 hours after the first antibiotic treatment. Without taking antibiotics, both the course of the disease and the risk of infection are prolonged. As a rule, a rash during a scarlet fever infection does not cause itching.
In these cases, a soothing and moisturizing cream is beneficial for irritated skin, especially to protect the lower skin layer when the characteristic scaling and detachment of the skin occurs. In case of itching, Imiquimod cream can be applied to the affected skin areas. In children who suffer from an itchy rash, care should be taken to prevent scars caused by excessive scratching, for example by wearing gloves at night.