This is a disease of childhood. It is caused by a Group A beta hemolytic strep. The majority of cases occur under the age of ten. It is most common in the fall and winter. The bacteria produces a toxin that causes the skin effects. The onset of the disease is usually sudden starting with a sore throat and viral like symptoms such as headaches, fatigue, chills and high fever. Abdominal pain and vomiting can occur.
The rash starts one or two days after this with redness most often in the neck , chest and armpits. The rest of the body quickly becomes involved. Small red papules develop. This has been described as sunburn with goose bumps. It feels rough like sandpaper. There are streaks of bruises particularly in the folds of the body. The cheeks are red although the skin is white around the mouth. After a week to ten days there is peeling of the skin most marked on the hands and feet. This may last for up to one month and sometimes longer.
Treatment is oral antibiotics such as erythromycin.
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