Scarlet fever

What is scarlet fever?

Despite its name, scarlet fever’s classic symptom isn’t a fever at all; instead it is a bright red rash. Scarlet fever is a bacterial infection caused by group A streptococcus or “group A strep” that typically affects children between the ages of 5–18 years. A throat culture (using a cotton swab at the back of the throat) makes it easy to diagnose the illness, and the only treatment required is antibiotics. Scarlet fever, if left untreated, can lead to serious complications such as ear infection, skin infection, throat abscess, kidney disease, and rheumatic fever—a rare condition that can cause permanent heart damage.

How do children get scarlet fever? 

The bacteria (group A strep) that cause scarlet fever spread through droplets in the air when an infected person sneezes or coughs. Other sources of infection include direct contact with infected individuals (children or adults) or contaminated objects (shared toys, utensils, etc.).

What are the symptoms of scarlet fever?

Scarlet fever’s signature red rash typically begins with red blotches on the neck, chest, and abdomen. The rash spreads and the blotches turn into tiny bumps, which feel like sandpaper. The rash can spread over the entire body, but it usually concentrates in the skin creases (elbows, armpits, and groin) where it can last up to seven days. In those areas where the rash is most intense, the skin may actually peel over several weeks. Although the rash is scarlet fever’s telltale sign, sore throat, fever (over 101º F), and headache usually occur first and the rash follows within 24 hours. Other symptoms of group A strep infection include: 

  • Whitish coating on the tongue or the back of the throat 
  • “Strawberry” tongue (surface of the tongue appears less smooth) 
  • Nausea and/or vomiting 
  • Swollen glands 
  • Body aches

How is scarlet fever treated? 

Children with a positive throat culture are treated with an antibiotic. Since scarlet fever is highly contagious, children should not return to school or child care until they are fever-free and have been on an antibiotic for at least 24 hours. The rash can last up to seven days, but after 24 hours of antibiotic treatment, your child is no longer considered contagious. While you are waiting for the antibiotic to fight your child’s infection, the following suggestions from the Mayo Clinic may help your child feel more comfortable:

  • Provide plenty of liquids to keep your child’s throat moist and to prevent dehydration 
  • Use a saltwater gargle; it may relieve the pain of a sore throat but it won’t shorten the length of the illness 
  • Humidify the air with a cool-mist humidifier (dry air may irritate an already sore throat) 
  • Offer older children throat lozenges (lozenges can be a choking hazard and should not be used in children under the age of 4 years) 
  • Provide soothing foods, such as soup or Popsicles 
  • Avoid irritants like cigarette smoke and cleaning products 
  • Treat fever and pain with non-aspirin pain relievers, such as ibuprofen or acetaminophen (your child’s health care provider can recommend the right dose)

How can scarlet fever be prevented? 

You can reduce the risk for scarlet fever and other infections by following these simple guidelines:

  • Wash hands frequently and teach your children the importance of handwashing. Review the tips from the Centers for Disease Control & Prevention for proper washing hands. 
  • Sneeze and cough into a tissue; if a tissue isn’t available, use your elbow or shoulder, rather than your hand. 
  • Don’t share drinking glasses or utensils. 
  • Wash toys and utensils in hot, soapy water or in a dishwasher to prevent the spread of group A strep from one family member to another.

When should I call a doctor? 

The American Academy of Pediatrics (AAP) urges parents to contact their child’s health care provider at the first sign of a sore throat, especially when a rash or fever is present. While scarlet fever is most common in children over the age of 5, younger children are also at risk. A young child may not be able to communicate a sore throat, so parents should call their child’s health care provider at the first sign of fever and/or rash. 

There are numerous childhood rashes. Tips for identifying your child’s rash can be found here.

Last updated June 9, 2020

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