Scarlet Fever: All You Need to Know

A doctor examines a young girl’s throat using a tongue suppressor. Smiling mother in background.

If your child has a sore throat and a rash, it may be scarlet fever (also called scarlatina). Your child’s doctor can do a quick strep test to find out. If your child has scarlet fever, antibiotics can help your child feel better faster and prevent long-term health problems. Antibiotics can also help protect others from getting sick.

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Bacteria Cause Scarlet Fever

Bacteria called group A Streptococcus or group A strep cause scarlet fever. The bacteria sometimes make a poison (toxin), which causes a rash — the “scarlet” of scarlet fever.

How You Get Scarlet Fever

Group A strep live in the nose and throat and can easily spread to other people. It is important to know that all infected people do not have symptoms or seem sick. People who are infected spread the bacteria by coughing or sneezing, which creates small respiratory droplets that contain the bacteria.

People can get sick if they:

Breathe in those droplets
Touch something with droplets on it and then touch their mouth or nose
Drink from the same glass or eat from the same plate as a sick person
Touch sores on the skin caused by group A strep (impetigo)

Rarely, people can spread group A strep through food that is not handled properly (visit CDC’s food safety page). Experts do not believe pets or household items, like toys, spread these bacteria.

Common Signs, Symptoms of Scarlet Fever

Very red, sore throat
Fever (101 °F or higher)
Whitish coating on the tongue early in the illness
“Strawberry” (red and bumpy) tongue
Red skin rash that has a sandpaper feel
Bright red skin in the creases of the underarm, elbow, and groin (the area where your stomach meets your thighs)
Swollen glands in the neck

Other general symptoms:

Headache or body aches
Nausea, vomiting, or abdominal pain

Scarlet Fever: What to Expect

In general, scarlet fever is a mild infection. It usually takes two to five days for someone exposed to group A strep to become sick. Illness usually begins with a fever and sore throat. There may also be chills, vomiting, or abdominal pain. The tongue may have a whitish coating and appear swollen. It may also have a “strawberry”-like (red and bumpy) appearance. The throat and tonsils may be very red and sore, and swallowing may be painful.

One or two days after the illness begins, a red rash usually appears. However, the rash can appear before illness or up to 7 days later. The rash may first appear on the neck, underarm, and groin (the area where your stomach meets your thighs). Over time, the rash spreads over the body. The rash usually begins as small, flat blotches that slowly become fine bumps that feel like sandpaper.

Although the cheeks might look flushed (rosy), there may be a pale area around the mouth. Underarm, elbow, and groin skin creases may become brighter red than the rest of the rash. The rash from scarlet fever fades in about 7 days. As the rash fades, the skin may peel around the fingertips, toes, and groin area. This peeling can last up to several weeks.

Children and Certain Adults Are at Increased Risk

Anyone can get scarlet fever, but there are some factors that can increase the risk of getting this infection.

Scarlet fever, like strep throat, is more common in children than adults. It is most common in children 5 through 15 years old. It is rare in children younger than 3 years old. Adults who are at increased risk for scarlet fever include:

Parents of school-aged children
Adults who are often in contact with children

Close contact with another person with scarlet fever is the most common risk factor for illness. For example, if someone has scarlet fever, it often spreads to other people in their household.

Infectious illnesses tend to spread wherever large groups of people gather together. Crowded conditions can increase the risk of getting a group A strep infection. These settings include :

Schools
Daycare centers
Military training facilities

Doctors Can Test for and Treat Scarlet Fever

Many viruses and bacteria can cause an illness that includes a red rash and sore throat. Only a rapid strep test or a throat culture can determine if group A strep are the cause.

A rapid strep test involves swabbing the throat and testing the swab. The test quickly shows if group A strep are causing the illness. If the test is positive, doctors can prescribe antibiotics. If the test is negative, but a doctor still suspects scarlet fever, then the doctor can take a throat culture swab. A throat culture takes time to see if group A strep bacteria grow from the swab. While it takes more time, a throat culture sometimes finds infections that the rapid strep test misses. Culture is important to use in children and teens since they can get rheumatic fever from an untreated scarlet fever infection. For adults, it is usually not necessary to do a throat culture following a negative rapid strep test. Adults are generally not at risk of getting rheumatic fever following scarlet fever.

Antibiotics Get You Well Fast

Doctors treat scarlet fever with antibiotics. Either penicillin or amoxicillin are recommended as a first choice for people who are not allergic to penicillin. Doctors can use other antibiotics to treat scarlet fever in people who are allergic to penicillin.

Benefits of antibiotics include:

Decreasing how long someone is sick
Decreasing symptoms (feeling better)
Preventing the bacteria from spreading to others
Preventing serious complications like rheumatic fever

Long-term Health Problems Are Not Common but Can Happen

Complications are rare but can occur after having scarlet fever. This can happen if the bacteria spread to other parts of the body. Complications can include:

Abscesses (pockets of pus) around the tonsils
Swollen lymph nodes in the neck
Ear, sinus, and skin infections
Pneumonia (lung infection)
Rheumatic fever (a heart disease)
Post-streptococcal glomerulonephritis (a kidney disease)
Arthritis (joint inflammation)

Treatment with antibiotics can prevent most of these health problems.

Protect Yourself and Others

People can get scarlet fever more than once. Having scarlet fever does not protect someone from getting it again in the future. While there is no vaccine to prevent scarlet fever, there are things people can do to protect themselves and others.

A young boy washes his hands with soap and water

Good Hygiene Helps Prevent Group A Strep Infections

The best way to keep from getting or spreading group A strep is to wash your hands often. This is especially important after coughing or sneezing and before preparing foods or eating. To practice good hygiene you should:

Cover your mouth and nose with a tissue when you cough or sneeze
Put your used tissue in the waste basket
Cough or sneeze into your upper sleeve or elbow, not your hands, if you don’t have a tissue
Wash your hands often with soap and water for at least 20 seconds
Use an alcohol-based hand rub if soap and water are not available

You should also wash glasses, utensils, and plates after someone who is sick uses them. These items are safe for others to use once washed.

Antibiotics Help Prevent Spreading the Infection to Others

People with scarlet fever should stay home from work, school, or daycare until they:

No longer have a fever
AND
Have taken antibiotics for at least 24 hours

Take the prescription exactly as the doctor says to. Don’t stop taking the medicine, even if you or your child feel better, unless the doctor says to stop.