Scarlet fever, an infection with toxin-producing group A beta-hemolytic streptococci, usually begins from an infection in the throat. Symptoms of this infection include sore throat, headache, enlarged tonsils, fever, and chills. Nausea, vomiting, and abdominal pain can accompany these symptoms. The tongue can be swollen and have a red, bumpy appearance sometimes referred to as "strawberry" tongue. A rash is also characteristic of scarlet fever. It usually begins as small, flat red areas on the skin and can develop into small, bumpy red areas. It usually begins on the chest and trunk and extends to the arms and legs, but the palms and soles of the feet are usually spared. The rash has been described as feeling like sandpaper. Skin creases (groin, elbows, underarms) may appear more reddened. The skin can start to peel as the rash fades.