One can describe sandpaper rash (scarlet fever) as a sore throat with a red rash. It makes your skin feel like sandpaper. It commonly affects children but can also occur in adults. The disease can cause rheumatic fever, kidney problems, pneumonia, arthritis, sinus infection, and other long-term complications if not treated properly. Continue reading to discover what causes sandpaper rash and the conventional treatments and home remedies used to cure the condition and relieve the symptoms.
What is Sandpaper Rash in Children?
Sandpaper rash is the common term for a bacterial illness that occurs in some people with a sore throat (and sometimes streptococcal skin infections).
Also referred to as scarlatina, the condition is characterized by a distinctive brightly colored pink-red skin rash. The rash shows on the torso (chest, stomach, and back), elbows, neck, and inner thighs among other areas of the body.
Sandpaper rash is notable for a rough texture that feels like sandpaper, hence the name. Sandpaper rash is highly contagious. Children between the age of 2 and 10 years are at the highest risk of contracting the disease.
At one point in time, the rash was considered a serious childhood illness, but that is no longer the case as it is now easily treated with antibiotics.
What Causes Sandpaper Rash
Sandpaper rash is caused by an infection with group A streptococcus bacteria (group-A strep). Also referred to as Group A beta-hemolytic streptococci (GAHBS), these are the same bacteria responsible for a sore throat.
The rash occurs when the bacteria involved make and release erythrogenic toxin. The toxin is also responsible for the red tongue experienced by some individuals.
The rash only affects a small portion of people with a sore throat (about 10 percent) or streptococcal skin and wound infections. This is because most people are not sensitive to the toxins. That is to mean that two children – or adults for that matter – can suffer from a sore throat at the same time, with only one of them developing the rash.
The incubation period for sandpaper rash (the time it takes for symptoms to appear after an infection) is 12 hours to 7 days after contracting the bacteria. As the NHS Choices however says, the symptoms appear more commonly between 2 and 5 days.
How is Sandpaper Rash Contracted?
The bacteria that cause sandpaper rash are transmitted from one person to another through the tiny water droplets expelled through the mouth and nose when an infected person sneezes or coughs.
One can also contract the disease when he touches the nose or mouth with hands that are contaminated by touching objects that have the bacteria. Factors such as overcrowding and sharing of items such as towels and utensils put you at higher risk of contracting the rash.
The contagious period for sandpaper rash begins around 12 hours after exposure to the bacteria and runs through to at least 12 hours after the red rash clears. Even a person who shows no symptoms yet can still spread the bacteria during this period.
Sandpaper Rash in Adults
About 80 percent of sandpaper rash cases occur in children aged between 2 and 8 years. This disease can, however, afflict anyone at any age, even in adult years.
As is the case with children, adults with the rash are likely to affect other people in close contact with them. Also, only adults with susceptibility to the streptococcus bacteria toxin responsible for the rash will develop it.
Sandpaper rash in adults typically responds to treatment with antibiotics. Patient rarely gets recurrent bouts of the rash as the body typically develops immunity to the culprit bacteria.
Sandpaper Rash Symptoms
Sandpaper rash is usually preceded by a sore throat or a skin infection involving group-A strep such as impetigo and is almost always accompanied by high fever.
At the onset, the following symptoms will usually appear:
- Sore throat
- Fever of 101ºFahrenheit (38ºC) or higher. Only a few milder cases will have no fever.
- Flushed cheeks: On the face, the disease manifests itself in red cheeks coupled with the skin around the mouth developing pale areas.
- A whitish coating on the tongue with numerous red spots. Some people refer to this as a “strawberry tongue.” The entire tongue may then turn red several days down the line.
- Swollen neck (lymph) glands
A characteristic pink-reddish, often itchy rash which feels like sandpaper to touch then follows 1-2 days later. This is the most apparent symptom of “sandpaper rash” and looks a lot like a sunburn. Some milder cases of the disease may have no other symptoms other than the rash.
The rash typically shows up on the chest and stomach before spreading over the body to other areas such as the elbows, ears, neck, groin, and legs (especially inner thigh). It is often not readily visible in darker-skinned regions of the skin, but one cannot mistake the rough texture. When one exerts pressure on the affected area of skin, the rash changes color to white.
The rash lasts 7 to 14 days after which peeling of the upper layers of skin begins. The skin around the hands, feet, and groin area may peel for a few weeks after the rash has faded.
In addition to the pink-red rash, you may experience the following symptoms:
- Throwing up
- Lack of appetite
- Pastia’s lines in folded areas of the skin: The creases of the armpits, groin, elbows, knees, and neck may become brighter red than the surrounding areas of skin.
Sandpaper Rash Pictures
A fine, pink-red rash on several areas of the body including the neck, chest, back, and arms among others typically characterize a sandpaper rash. The pictures below will give you an idea how the rash looks like:
Sandpaper Rash Treatment
Sandpaper rash usually clears up on its own (without treatment) in a week or so. Even then, treatment is recommended. It helps to not only cut down the contagious period but also shorten the recovery time (to around 4-5 days) and reduce the risk of complications such as rheumatic fever.
Take your child to the doctor if you suspect s/he might have the rash.
Sandpaper rash treatment usually involves a prescription of antibiotics to kill the group-A strep bacteria that cause the infection, generally over a 10-day course. For children, liquid antibiotics such as amoxicillin and penicillin are preferred.
You will see an improvement in the symptoms in just a few days but ensure that your child still completes the full dose of antibiotics.
After 24 hours of treatment with antibiotics, children can safely resume school and adult can continue with their daily schedules.
Home Care Remedies for Sandpaper Rash
Doctors recommend treating the rash with antibiotics. No home remedy can take the place of antibiotics. Seeing, or taking your child to, a doctor is essential.
After treatment, you can then take the following self-care measures to relieve the symptoms – especially fever – as the rash heals at home:
- Avoid hard foods and snacks. Instead, eat soft foods and soups to avoid irritating the throat further and possibly increasing throat pain.
- Take over the counter medications such as paracetamol, ibuprofen (Advil, Motrin, etc.), or acetaminophen (Tylenol) to get rid of fever and throat pain.
- Apply calamine lotion to the rash if it itches. Antihistamine tablets can also help to soothe the itching.
- Take – or give the affected child – plenty of cool water and other fluids. This will help to keep the throat moist.
- Gargle with salt water and then spit it out to relieve the throat pain.
- Run a humidifier to keep the air around the house moist. Dry air can irritate the throat even further.
- Suck some medicated lozenges. Children below the age of 4 should however not use lozenges.
- Avoid cigarette smoke, fumes and other irritants that can aggravate the throat irritation.
- Bryant, A. E., and Stevens D. L. Streptococcus pyogenes. In: Bennett J. E, Dolin, R., and Blaser, M. J., eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Health Sciences, 2015.
- Mayo Clinic: Scarlet Fever Lifestyle and Home Remedies
- NHS Choices: Skin Rashes In Children