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Overview

What Is Scarlet Fever?

Scarlet fever is a contagious infection caused by group A Streptococcus bacteria. Another name for it is scarlatina. Children are the most commonly affected group, and the infection often occurs along with strep throat. In simple terms, scarlet fever is group A strep infection that can cause a characteristic fine, rough-textured rash.

Symptoms

Scarlet Fever Symptoms

  • Sore throat
  • Fever
  • Fine, rough-textured rash (sandpaper-like rash)
  • Flushed cheeks
  • Red, bumpy strawberry tongue
  • Swollen neck glands (enlarged lymph nodes)
  • Headache
  • Nausea or vomiting
  • Body aches

The rash often appears 12 to 48 hours after other symptoms begin, although timing can vary. It may start on the chest, abdomen, or under the arms and then spread to other parts of the body. The rash can look different on different skin tones and may be easier to feel than to see, so a healthcare professional should assess suspected scarlet fever.

When to get help

Seek prompt medical advice

Contact a healthcare professional promptly if a child has fever with a rash, trouble swallowing, breathing difficulty, signs of dehydration, or worsening illness.

How It Spreads

How Scarlet Fever Spreads

Group A strep can spread through respiratory droplets and close contact. Coughing, sneezing, saliva, and sharing utensils or cups can pass the bacteria between people. Someone may spread the bacteria even when symptoms are not obvious, so close contacts should follow local medical guidance if exposure occurs.

  • Wash hands often with soap and water, especially after coughing, sneezing, or caring for someone who is ill.
  • Cover coughs and sneezes with a tissue or the elbow rather than the hands.
  • Avoid sharing cups, utensils, towels, toothbrushes, or other personal items.
  • Stay home while contagious and follow medical advice about returning to normal activities.
  • Follow the clinician’s guidance about when it is safe to return to school or childcare.

Risk Factors

Risk Factors for Scarlet Fever

  • Being school-age or a young child
  • Close contact with someone who has a group A strep infection
  • Attending a crowded setting such as a school or childcare center
  • Seasonal increases in respiratory infections

Exposure-related factors, such as close contact and crowded settings, can sometimes be reduced with hand hygiene and other precautions. Age and exposure to circulating infections in the community cannot be fully controlled. Scarlet fever is not a result of poor hygiene, although good hygiene can help reduce the spread of group A strep.

Complications

Scarlet Fever Complications

Complications are uncommon when scarlet fever is diagnosed and treated appropriately. However, the infection can spread to nearby areas such as the ears, sinuses, skin, or deeper tissues. Delayed complications can also occur when the immune system reacts after the original infection.

  • Ear infection (otitis media)
  • Sinus infection (sinusitis)
  • Pneumonia
  • Abscess around the tonsils (peritonsillar abscess)
  • Rheumatic fever, a delayed immune-related complication
  • Post-streptococcal kidney inflammation (post-streptococcal glomerulonephritis)

Seek urgent care

Watch for worsening illness

Seek urgent medical evaluation for breathing difficulty, severe dehydration, confusion, chest pain, dark or reduced urine, facial swelling, or rapidly worsening symptoms.

Diagnosis

How Scarlet Fever Is Diagnosed

Clinicians assess the rash, throat, tongue, fever, and nearby lymph nodes during an examination. However, appearance alone cannot reliably confirm scarlet fever. Testing for group A strep is usually needed to help guide treatment.

Rapid strep test

A rapid strep test detects group A strep from a throat swab and can provide results quickly. It may miss some infections, so a child with a negative rapid test may need a follow-up throat culture.

Throat culture

A throat culture also tests a throat swab for group A strep and is more sensitive than a rapid test. It takes longer to return results, but it can identify infections that a rapid test misses.

Treatment & Management

Treatment and Management

Confirmed or clinically suspected scarlet fever is treated with prescribed antibiotics. Penicillin or amoxicillin is commonly used when appropriate, while the prescriber selects an alternative for people with relevant allergies. Antibiotics for scarlet fever should be taken only as directed by a healthcare professional.

  • Complete the full antibiotic course, even if symptoms improve sooner.
  • Use clinician-approved medicine for fever or pain relief.
  • Drink enough fluids to help prevent dehydration.
  • Choose soft foods if swallowing is painful.
  • Rest while recovering.
  • Avoid sharing cups, utensils, towels, or other personal items.

Medication safety

Use antibiotics exactly as prescribed

Do not use leftover antibiotics or stop treatment early. Contact the prescriber if symptoms worsen or a medication reaction develops.

Prevention

Preventing Scarlet Fever

  • Wash hands frequently with soap and water.
  • Cover coughs and sneezes with a tissue or the elbow.
  • Do not share cups, utensils, or other personal items.
  • Clean frequently touched surfaces regularly.
  • Stay home while contagious and follow medical advice about returning to school or childcare.

There is no routinely available vaccine specifically for scarlet fever. Reducing close-contact spread, practicing good hand hygiene, and obtaining prompt evaluation for symptoms are the main prevention strategies. Appropriate treatment also helps limit transmission.

Outlook and Prognosis

Outlook and Prognosis

Most people recover fully from scarlet fever with timely antibiotic treatment and supportive care. Symptoms such as sore throat and rash may take several days to improve. Prompt treatment also lowers the risk of complications and helps reduce the chance of spreading the infection.

When Should You See a Doctor

When Should You See a Doctor?

Emergency care

Get immediate help for severe symptoms

Seek immediate medical help for trouble breathing or swallowing, severe dehydration, blue or gray lips, unusual sleepiness or confusion, severe neck swelling, or a rapidly spreading infection.

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