Is strawberry tongue necessarily scarlet fever? No, not necessarily. Strawberry tongue is common in patients with scarlet fever or prolonged fever. In the early stage, the tongue is white and the papillae, which are the papillae on the back and sides of the tongue, are enlarged and reddened. In the late stage, the tongue coating disappears, and the enlarged tongue papillae are strawberry-shaped, sometimes also called prune tongue. Scarlet fever, in addition to strawberry tongue, has other more important clinical manifestations, such as its onset, which begins with a sudden sore throat, headache, chills, nausea, and fever. From about 12-48 hours, a rash starts to appear on the neck, chest and armpits, and in about 4-6 hours, the rash is characterized by tiny papules on erythematous patches, which recede in redness when pressed by hand and feel like sandpaper, and bright red circles start to appear on the tongue, all of which turn red later. Skin flaking begins after 1 week of onset and may last for a few weeks or so.