Snapshot An 8-year-old girl presents to the pediatrician’s office for a recent illness. She has a sore throat and a diffuse rash that has started to peel. On physical exam, she has a diffuse sandpaper-like rash on her trunk and extremities that spares her palms and soles. The physician also notes circumoral pallor. Concerned about complications of this condition, her physician prescribes a 10-day course of amoxicillin. Introduction Clinical definition acute bacterial infection with diffuse erythematous eruption associated with pharyngitis Epidemiology Demographics children Risk factors exposure to Streptococcus pyogenes or other erythrogenic strains ETIOLOGY Pathogenesis delayed-type hypersensitivity to S. pyogenes exotoxin A Associated conditions streptococcal pharyngitis Presentation Symptoms sore throat fever Physical exam strawberry tongue circumoral pallor diffuse blanching erythema sandpaper-like rash with small papules spreads from the groin and armpits and to the trunk and extremities spares the palms and soles the rash is followed by desquamation Studies Labs rapid streptococcal testing throat culture may reveal streptococcal pharyngitis Differential Kawasaki disease distinguishing factors hand and foot rash prolonged fever conjunctival injection no association with streptococcal pharyngitis Staphylococcal scalded skin syndrome distinguishing factors + Nikolsky sign DIAGNOSIS Making the diagnosis based on clinical presentation Treatment Management approach identical to the treatment approach in patients with streptococcal pharyngitis additional treatment for the rash is not needed Medical penicillin indications for all patients prevention of acute rheumatic fever drugs penicillin V amoxicillin alternatives to penicillin indications for patients with penicillin allergies prevention of acute rheumatic fever drugs cephalosporins clindamycin macrolides Complications Acute rheumatic fever Rheumatic heart disease Prognosis Rash usually fades within a week Desquamation may last several weeks