Scarlet Fever

Scarlet fever is caused by group A Streptococcus, the same bacteria that causes strep throat. Scarlet fever causes a red, bumpy rash all over your body, hence the name. It affects mostly children, but it can affect adults too. While symptoms are uncomfortable (fever, sore throat, rash), antibiotic treatment will clear scarlet fever up quickly.


What is scarlet fever?

Scarlet fever (scarlatina) is an infection caused by group A Streptococcus bacteria. It’s the same bacteria that causes strep throat. The bacteria create a toxin (poison) that causes a bright red rash that spreads all over your body. That’s why it’s called scarlet fever. The rash is also bumpy, so it’s sometimes called a sandpaper rash.


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What is scarlet fever tongue?

One of the symptoms of scarlet fever is a swollen tongue that appears red and bumpy. Some people think it looks like a strawberry. It’s sometimes called strawberry tongue.

Who does scarlet fever affect?

Scarlet fever is most common in children between the ages of 5 to 15, but it can affect people of all ages.


Symptoms and Causes

What causes scarlet fever?

A bacteria called group A beta-hemolytic Streptococcus or group A strep causes scarlet fever. The bacteria produce a toxin that leads to the red rash the infection is named for. Group A strep causes strep throat and impetigo and can result in rheumatic fever.

How do you get scarlet fever?

The bacteria group A strep lives in your ears, nose, throat and on your skin. People who are infected can easily spread it by coughing or sneezing. Coughing or sneezing creates tiny droplets that contain the bacteria. These droplets are sent out into the air. You can get sick if you:

  • Breathe in the tiny droplets.
  • Touch a surface containing the droplets and then touch your nose or mouth.
  • Eat from the same plate or drink from the same glass as someone who is sick.
  • Touch sores on the skin caused by group A Streptococcus.

Very rarely, people can get group A strep by eating food that hasn’t been handled properly. Scientists don’t believe Group A strep can be spread by touching pets or household items like toys.


What are the symptoms of scarlet fever?

The first symptoms to appear are usually fever and sore throat. The most obvious sign of scarlet fever is a red, bumpy rash. However, fewer than 10% of strep cases have an accompanying rash.

Rash symptoms:

  • A red rash may first appear around your neck and chest.
  • The rash may spread to your back, arms, legs and face.
  • There may be a pale area around your mouth.
  • Skin creases and petechiae (small red or purple bumps) in your underarms, elbows and groin may become brighter red than the rest of the rash (pastia lines).
  • Peeling may be prevalent seven to 10 days after the rash fades, especially on your fingers.

Mouth and throat symptoms:

  • Your tongue may develop a white-colored coating.
  • Your tongue may appear swollen, red and bumpy and look like a strawberry.
  • Your tonsils and throat may be swollen, red and sore.
  • Your tonsils and throat may have a white or yellow coating or dots of white or yellow pus.
  • You may have difficulty swallowing.

Other symptoms you may experience include:

What does scarlet fever rash look like?

Scarlet fever rash typically starts as small, flat splotches on your skin. The splotches will slowly turn into fine bumps. The rash may look like a bad sunburn. Others describe the rash as looking and feeling rough like sandpaper.

Is scarlet fever contagious?

Scarlet fever is contagious. It spreads through droplets in the air that people pass on when coughing or sneezing.

Who is at risk for scarlet fever?

Anyone can get scarlet fever. It's more common in children ages 5 to 15 than in adults. Parents of children in this age range and other adults who frequently come into contact with children in this age range are more at risk. Scarlet fever is rare in babies and toddlers.

Your risk increases if you’re in close contact with a person who has scarlet fever. Scarlet fever spreads quicker in large group settings. Outbreaks in schools, daycares, communities and neighborhoods can increase your risk.

What are the complications of scarlet fever?

Complications from scarlet fever are rare. They can occur if the Group A strep spreads to other parts of your body. Complications can include:

Diagnosis and Tests

How is scarlet fever diagnosed?

Your healthcare provider will do a physical exam and ask you about your symptoms. They’ll usually do a rapid strep test to check for the group A strep bacteria. This test involves swabbing your throat and testing the sample. The test quickly shows if the bacteria is the cause of your illness. However, it can miss up to 30% of strep cases.

If the test comes back negative, your healthcare provider may do a throat culture. A throat culture takes approximately 24 to 48 hours to determine if bacteria grow from the sample. A throat culture sometimes finds infections that the rapid strep test misses.

Alternatively, your provider may give you a rapid molecular strep test to determine if you have strep throat. No culture is required with this test.

Management and Treatment

What is the treatment for scarlet fever?

If you test positive for scarlet fever, your healthcare provider will prescribe you antibiotics. The antibiotics will kill the bacteria causing the infection in your body. The antibiotics will shorten the amount of time you feel sick and have symptoms. The antibiotics will also prevent you from spreading the infection and prevent you from developing complications.

How can I take care of my child at home?

A sore and swollen throat can make eating painful. Serve your child soft foods and liquids, such as soup, slushies and tea. It’s important to keep your child hydrated. You can also gargle with salt water to help the throat pain.

You may give your child over-the-counter pain medications such as acetaminophen (Tylenol®) or ibuprofen (Advil®) for fever or pain. An anti-itch medicine can help relieve itching from the rash.


Is there a scarlet fever vaccine?

There is no vaccine for scarlet fever.

How can I prevent scarlet fever?

Scarlet fever is contagious. Group A strep bacteria spreads through droplets in the air when a person coughs or sneezes. You can prevent getting scarlet fever by:

  • Avoiding people who are infected with it.
  • Washing your hands with warm soap and water for 20 seconds on a regular basis.
  • Using an alcohol-based sanitizer if soap and water are not available.
  • Covering your mouth and nose when sneezing.
  • For the person who is infected with strep, keep the toothbrush separate from other family members.
  • If you have scarlet fever, you should stay home from school or work to help stop the spread.

Outlook / Prognosis

How long does scarlet fever last?

The antibiotics your healthcare provider prescribed you will quickly kill the bacteria. The rash from scarlet fever lasts for about a week. It may continue to peel for several weeks as your skin heals. You may still have swollen glands for a few weeks.

Living With

When should I see my healthcare provider?

You should call your healthcare provider if you or your child develops a rash. It’s also important to call if you or your child develops additional symptoms of scarlet fever, especially fever, sore throat or swollen glands.

After you start on antibiotics, you should call your healthcare provider if:

  • Your symptoms don’t improve 24 hours after starting treatment.
  • You develop new or worsening symptoms after starting treatment.

You’re at serious risk of complications if you don’t treat scarlet fever. It can result in rheumatic fever, which can lead to serious health problems.

When can I go back to work or school?

If you have scarlet fever, you should stay home from work or school until you no longer have a fever and you have taken antibiotics for at least 12 hours.

What questions should I ask my doctor?

  • How likely am I to get scarlet fever if I’ve had strep throat?
  • How long do I need to take my antibiotics?
  • What can I do if I’m allergic to penicillin?

Additional Common Questions

Can I get scarlet fever twice?

You can get scarlet fever more than once. Having scarlet fever once doesn’t prevent you from getting it again.

How serious is scarlet fever?

In the early 20th century, scarlet fever used to be more common and severe, especially among children. It was once a very serious childhood disease. With advances in hygiene and medicine, it is now very treatable. However, it can lead to major health issues if it’s not treated.

A note from Cleveland Clinic

Fever? Sore throat? Red, bumpy rash? Time to call your healthcare provider because you may have scarlet fever. While the symptoms of scarlet fever are uncomfortable, thankfully there’s treatment for this strawberry-tongued, sandpapery rash. Your healthcare provider will be able to quickly tell if you have scarlet fever. If you do, they will prescribe antibiotics and you’ll be feeling better in no time. Make sure to get treated. Scarlet fever is no fun, but not getting treatment could lead to a worse health condition.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 05/24/2022.

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