Children's Health and Wellness

Scarlet Fever

What is scarlet fever?

Scarlet fever, also known as scarlatina, is an infectious disease that causes a rash. It is associated with the same kind of bacteria that causes strep throat. It may also be associated with infected wounds or burns. The rash of scarlet fever is typically a fine, "sandpaper-like" rash that consists of small, red bumps.

Scarlet fever most commonly occurs in children between 5 and 12 years old. 

What causes scarlet fever?

Scarlet fever is caused by bacteria called group A beta-hemolytic streptococcus (GABHS). These bacteria release a toxin that travels through your child's bloodstream and causes a rash. The Strep A bacteria lives in the nose and throat. When someone who has the disease coughs or sneezes, the bacteria is spread onto surfaces. If you touch one of these surfaces and then rub your nose, mouth, or eyes, you can get the disease. You can also get it from drinking or eating with utensils used by someone who is sick. Contact with open sores from group A strep skin infections can also spread the disease.

What are the symptoms of scarlet fever?

These are the most common scarlet fever symptoms that develop before the rash:

  • Fever

  • Sore throat

  • Chills

  • Headache

  • Vomiting

  • Stomachache

  • Coated white tongue

  • Strawberry-like appearance of the tongue

The rash starts about 1 to 2 days after the initial infection. The red, fine, sandpaper-like rash typically is noted on the neck, forehead, cheeks, and chest and then may spread to the arms and back. The rash usually starts to fade after 2 to 7 days. It is not uncommon for the skin to peel after the infection has resolved, especially over the hands, feet, or genital area.

The symptoms of scarlet fever may look like other skin conditions or medical problems. Always see your child's healthcare provider for a diagnosis.

How is scarlet fever diagnosed?

Your child's healthcare provider will make the diagnosis based on a complete medical history and physical exam. The rash of scarlet fever is unique and may be easily recognized by your child's provider. In addition, your child's healthcare provider may do a throat swab to confirm the diagnosis of strep throat as the source of the scarlet fever. A quick test, called a rapid strep test, may be done. This may immediately test positive for GABHS. However, if it is negative, part of the throat swab may be sent for a throat culture to further identify if there is any GABHS present.

What is the treatment for scarlet fever?

Treatment for scarlet fever is the same as for strep throat. Your child's healthcare provider will prescribe an appropriate antibiotic to treat the infection. Untreated strep throat or scarlet fever can lead to several serious conditions involving the heart, kidneys, and liver. When the heart is involved, it is called rheumatic fever, so it is very important to finish the full course of antibiotics. Other treatment options may include:

  • Warm saline mouth gargles (to relieve the sore throat)

  • Acetaminophen or ibuprofen (for fever or throat pain). Never give aspirin to a child, it can cause a dangerous condition called Reye Syndrome.

  • Increased fluid intake

It is important not to send your child back to school or day care until he or she has been on antibiotics for at least 24 hours. Also, be sure to notify others who may have been exposed.

How can scarlet fever be prevented?

The best way to prevent scarlet fever is to wash your hands often. Avoid sharing eating utensils, linens, towels, or other personal items. Anyone who has a sore throat should wash his or her hands often. To wash your hands:

  • Hold them under clean running water. Turn off the water and rub soap all over your hands.

  • Rub your soapy hands together for at least 20 seconds. Be sure to scrub under your nails, between your fingers, and up your arm.

  • Rinse well under clean running water.

  • Dry using a clean towel or air dry.

If soap and water are not available, use an alcohol-based cleanser with at least 60% alcohol.

There is no vaccine to prevent strep throat or scarlet fever. Children who have strep throat or scarlet fever should not go to school or to daycare for at least 24 hours after starting antibiotics.

Print Source: Complications of streptococcal tonsillopharyngitis, Up To Date
Print Source: Lowth, M. Infectious Diseases in Children, Practice Nurse (2013); 43; 7
Online Source: Centers for Disease Control and Prevention. Scarlet Fever: A Group A Streptoccal Infection
Online Source: American Academy of Pediatrics. Scarlet Fever
Online Source: Types of Group A Streptococcal Infections, National Institute of Allergy and Infectious Diseases
Online Editor: Metzger, Geri K.
Online Medical Reviewer: Freeborn, Donna, PhD, CNM, FNP
Online Medical Reviewer: Lentnek, Arnold, MD
Date Last Reviewed: 10/1/2016
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