The rash begins 1–2 days following the onset of symptoms caused by the strep pharyngitis (sore throat, fever, fatigue). This characteristic rash has been denoted as "scarlatiniform" and it appears as a diffuse redness of the skin with small papules, or bumps, which resemble goose pimples. These bumps are what give the characteristic sandpaper texture to the rash. The reddened skin will blanch when you apply pressure to it. It is possible for the skin to be itchy, but it will not be painful. It usually first appears on the trunk and then gradually spreads out to the arms and legs. The palms, soles and face are usually left uninvolved by the rash. The face, however, is usually flushed, most prominently in the cheeks, with a ring of paleness around the mouth. After the rash spreads, it becomes more pronounced in creases in the skin, such as the skin folds in the inguinal and axillary regions of the body. Also in those areas it is possible for there to be Pastia’s Lines which are petechiae arranged in a linear pattern. Within 1 week of onset the rash begins to fade followed by a longer process of desquamation, or shedding of the outer layer of skin, which lasts several weeks. The desquamation process usually begins on the face and progresses downward on the body. After the desquamation the skin will be left with a sunburned appearance.