Scarletina is a rash caused by infection somewhere in the body (usually the throat but often other places) with the Group A beta-hemolytic Streptococcus germ. (Scarlet fever is the full blown syndrome of untreated Strep infection with a much worse rash.) There are many strains of Streptococcus germ; this is the one that causes this rash. The immune system forms antibodies that cross react with not only parts of the Strep germ that act as a toxin but also normal tissues in the blood vessels of the body. When this happens in the skin, the blood vessels are injured, dilate, and a characteristic red, sandpapery rash develops. It is often first noted in the underpants area - where the skin stays the warmest.

If you suspect this rash, even in a child with no complaint of sore throat, you should get medical attention for proper diagnosis and treatment with complete course of an antibiotic. Group A Strep infections carry a small but definite risk of further reaction with the heart (rheumatic fever), which can cause permanent damage to the heart valves, or with the kidneys, causing dangerously high blood pressure (acute glomerulonephritis), or with the brain, causing a bizarre movement disorder (chorea, pronounced like Korea). The scarletina rash is also something to watch out for in any child with chickenpox because it may indicate a secondary infection with this potentially bad-acting germ. Call your doctor right away if you see a scarletina rash with known or suspected chickenpox.

A week or two after the rash fades you may notice some peeling of the skin especially of the arms and chest, and perhaps even peeling of the fingers and toes if the rash was severe. This is normal and harmless.

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