Scarlet Fever
Also known as Scarlatina
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is scarlet fever?
Scarlet fever is caused by group A Streptococcus bacteria producing a toxin that generates a distinctive fine red rash with a sandpaper texture, alongside sore throat and fever. Once greatly feared, it is now readily treated with antibiotics, which also prevent rheumatic fever and other complications.
Causes
- Group A Streptococcus producing erythrogenic toxin
- Spread by respiratory droplets
- Contact with infected skin lesions
- Sharing food, drinks or utensils
Symptoms
- Sore throat and fever
- Fine red rash with a sandpaper texture
- Rash starting on the chest and spreading
- Flushed face with pallor around the mouth
- Strawberry tongue, initially white coated then red
- Red creases in the skin folds
- Peeling of the skin during recovery
- Swollen neck lymph nodes
Risk factors
- Age 5 to 15 years
- Close contact with an infected person
- School and nursery settings
- Winter and spring seasonality
- Crowded living conditions
Diagnosis
- Clinical recognition of rash with sore throat and fever
- Rapid antigen detection test for group A Streptococcus
- Throat culture
- Public health notification in many countries
- Distinguishing from measles, Kawasaki disease and drug rash
Treatment
- Penicillin V or amoxicillin for ten days
- Macrolides for penicillin allergy
- Antipyretics and adequate fluids
- Return to school 24 hours after starting antibiotics
- Completing the full course to prevent rheumatic fever
- Prompt review if symptoms worsen despite treatment
Self care
- Complete the full ten day antibiotic course
- Give paracetamol or ibuprofen for fever and sore throat
- Encourage cool soft foods and plenty of fluids
- Keep the child off school until 24 hours after antibiotics start
- Use calamine or emollient for itching
- Keep nails short to limit scratching
When to see a doctor
Book an appointment if:
- Suspected scarlet fever, since antibiotics are recommended
- No improvement after 48 hours of antibiotics
- Fever returning after initial recovery
- Joint pain or swelling weeks later
- Dark or reduced urine after the illness
- Another household member developing symptoms
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- There is no vaccine for group A Streptococcus
- Good hand hygiene and covering coughs
- Do not share cups, cutlery or towels
- Keep affected children off school until 24 hours after antibiotics
- Treat cases promptly to reduce spread
Outlook
Scarlet fever responds quickly to antibiotics and most children are much better within a day or two, with peeling skin continuing for a couple of weeks. Completing the course prevents rheumatic fever and kidney inflammation. Invasive streptococcal disease is rare but serious, which is why rapid deterioration warrants emergency assessment.
Common questions
How is the rash recognised?
It feels like fine sandpaper, blanches on pressure, usually begins on the chest and is more intense in skin creases such as the armpits and elbows. The area immediately around the mouth typically stays pale.
Is scarlet fever dangerous now?
With prompt antibiotics it is usually straightforward. Untreated, it can lead to rheumatic fever affecting the heart, kidney inflammation, or rarely invasive streptococcal disease, which is why treatment is recommended.
When should I seek urgent review?
Rapidly worsening illness, severe limb pain, difficulty breathing, a spreading painful area of skin, or a child who becomes drowsy or floppy may indicate invasive infection and needs emergency assessment.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.