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Rash

The characteristic rash has been denoted as "scarlatiniform", and it appears as a diffuse redness of the skin with small bumps resembling goose bumps. It typically appears as small flat spots on the neck or torso before developing into small bumps that spread to the arms and legs. It tends to feel rough like sandpaper. The cheeks might look flushed with a pale area around the mouth. The scarlet fever rash generally looks red on white and pale skin, and might be difficult to visualise on brown or black skin, in whom the bumps are typically larger, the skin less like sandpaper, and the perioral pallor less obvious. The palms and soles are spared. The reddened skin blanches when pressure is applied to it. The skin may feel itchy, but is not painful. A more intense redness on the inside of skin folds and creases might be noticed. These are lines of petechiae, appearing as pink/red areas located in arm pits and elbow pits. It takes around a week for the main rash to disappear. This may be followed by several weeks of peeling of the skin of typically fingers and toes. The desquamation process usually begins on the face and progresses downward on the body. Sometimes, this peeling is the only sign that scarlet fever occurred. If the case of scarlet fever is uncomplicated, recovery from the fever and clinical symptoms, other than the process of desquamation, occurs in 5–10 days. After the desquamation, the skin will be left with a sunburned appearance.