The rash of scarlet fever is best described as which of the following?

• A. maculopapular rash that blanches
• B. vesicular rash
• C. fine papular rash with sandpaper texture
• D. urticarial rash

Answer: (C)

Scarlet fever rash is best described as a fine papular eruption with a sandpaper-like texture. The tiny bumps create a rough feel on the skin and the rash blanches with pressure. It is usually diffuse, often starting on the trunk and spreading to the extremities, and is classically accompanied by circumoral pallor and later a strawberry tongue. This texture and pattern come from the streptococcal toxins causing widespread irritation of the skin. Vesicular rashes involve fluid-filled blisters (not sandpaper texture), urticarial rashes are hive-like wheals, and a general blanching maculopapular rash lacks the distinctive sandpaper texture.