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 wounds or burns that become infected. 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. 

Patients can be seen by Texas Children's experts in Infectious Disease.

Causes & Risk Factors

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.

Symptoms & Types

The following are the most common initial (before the rash develops) symptoms of scarlet fever. However, each child may experience symptoms differently. Symptoms may include:

  • Fever
  • Sore throat
  • Chills
  • Headache
  • Vomiting
  • Stomachache
  • Coated white tongue
  • Strawberry-like appearance of the tongue

The rash begins approximately one to two 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 begins 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 resemble other skin conditions or medical problems. Always see your child's health care provider for a diagnosis.

Diagnosis & Tests

Your child's health care 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 health care provider may order 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 performed. 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.

Treatment & Care

Treatment for scarlet fever is the same as for strep throat. Your child's health care provider will often 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 to not send your child back to school or day care until 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 thoat should wash their 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 percent 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.