Scarlet Fever

A 7-year-old boy presents with high-grade fever (39.5°C), sore throat, and a diffuse erythematous rash that began on the trunk and spread to extremities. On examination, he has cervical lymphadenopathy, beefy red pharynx with white-yellow exudates, and a white strawberry tongue. His skin shows a finely punctate, blanching rash with sandpaper texture, most prominent on the trunk and flexural areas, with Pastia lines visible in the antecubital folds. The face demonstrates flushed cheeks with a characteristic pale area around the mouth. Rapid strep test is positive for Group A Streptococcus. The structure marked **A** in the diagram represents the characteristic facial appearance in this condition. Which of the following best describes the rash pattern marked **A**?