Questionnaire/history:

Initial symptoms?

- Sore throat/tonsillitis?

- Fever (typically > 38.3°C)?

- Headache?

- Fatigue?

- Nausea?

- Vomiting?

Blanching, not itchy rash on the trunk 12–48 hours after initial symptoms, before spreading to neck, arms, legs and the rest of the body and flexures?

- Red, generalized and pinpoint (punctate) with a rough, sandpaper-like texture?

- Accentuated in the skin folds of the neck, axillae, groin, elbows, and knees with a deep red, linear appearance (so-called 'Pastia's lines')?- Palms and soles spared (typically)?

- Skin may peel after the rash resolves, particularly at the tips of the fingers and toes, and less commonly on the trunk and limbs?Strawberry tongue with initially the tongue covered with a white coat through which red papillae may be seen and later, the white covering disappears, leaving the tongue with a beefy red appearance?

Cervical lymph node swelling?Flushed face, with marked circumoral pallor?

Pharyngitis and small red spots (petechiae) on the hard and soft palate ('Forchheimer spots')?

Past medical history?

Current medication?

Drug allergies?

Examination:

Temperature?

Rash (as above)?

Strawberry tongue?

Cervical lymphadenopathy?

Flushed face with marked circumoral pallor?

Pharyngitis and small red spots (petechiae) on the hard and soft palate ('Forchheimer spots')

Cervical lymphadenopathy?

ImagesInvestigations:Throat swab for culture of Group A streptococcus (GAS) (prior to starting treatment) if:

- Uncertainty about the clinical diagnosis

- Case suspected to be part of an outbreak on advice of the local health protection team

- True allergy to penicillin to determine antimicrobial susceptibility, depending on clinical judgement

- Case is in regular contact with vulnerable people who are at high risk of complications, such as healthcare workers

Management

Reference(s):

NICE CKS: Scarlet fever

Information for patient/carer(s):

NHS Health A to Z: Scarlet fever

Patient UK: Scarlet fever