Scarlet Fever

Scarlet fever is a widespread rash you get from a group A strep infection. Group A strep is a type of bacteria that also causes strep throat and skin infections (impetigo). In fact, you most often get scarlet fever along with the symptoms of strep throat.

The rash is bumpy, rough and can spread over most of your body. It’s not harmful on its own, but the bacterial infection needs to be treated with antibiotics so it doesn’t progress to more serious health conditions.

Symptoms of scarlet fever

Scarlet fever causes a distinctive, bumpy rash. You often have other symptoms a day or two before the rash shows up, including:

• Fever
• Headache
• Body aches (myalgia)
• Sore throat
• Nausea, vomiting or stomach pain
• Tiredness or generally feeling unwell
• White coating on your tongue
• Red and bumpy tongue (strawberry tongue)
• Swollen lymph nodes (glands)
• Swollen tonsils with white patches or streaks
• Small red spots on the roof of your mouth (petechiae)
• Red, itchy sores that turn to scabs (impetigo)

What does the scarlet fever rash look like?

Scarlet fever rash is made up of tiny, rough bumps. It might feel a bit like sandpaper if you run your hand over it. If your skin is light, it’ll appear red or pink. If you have darker skin, it might look different from the surrounding skin, or it might be hard to see it. There’s often a pale area and/or a rash-free area around your mouth. Creases in the skin of your underarms, elbows and groin might be brighter red than the rest of the rash (pastia lines). Sometimes, the rash is itchy.

The rash might spread in stages:

• It usually appears first around your neck and chest.
• Then, it can spread to your back, arms, legs and face. The palms of your hands and soles of your feet often don’t have a rash.
• Your skin might peel seven to 10 days after the rash fades, especially on your fingertips.

Scarlet fever causes

Group A Streptococcus (strep A) bacteria cause scarlet fever. It’s the same bacteria that cause strep throat and impetigo, a skin infection. But not everyone who gets infected with the bacteria will get the rash.

Is scarlet fever contagious?

Yes, the bacteria that cause scarlet fever are contagious (spread from person to person). People who are infected can easily spread it by coughing or sneezing, which sends tiny droplets that contain the bacteria into the air. You can get infected if you:

• Breathe in the droplets
• Touch a surface containing the droplets and then touch your nose or mouth
• Share food or drinks with someone who’s infected
• Kiss someone who is infected
• Touch sores that contain the bacteria
• Eat food contaminated with the bacteria (this is rare)

Some people who are infected get no symptoms but can still spread the bacteria to others.

Risk factors

Kids between the ages of 5 and 15 are at the highest risk for scarlet fever. Experts aren’t sure why some people develop a rash from strep A and others don’t. You’re also at a higher risk of infection if you live or work with people in close contact with each other, like at a daycare, school or correctional facility.

You’re at higher risk for serious illness if you:

• Have a chronic health condition, like cancer, diabetes, or heart, kidney, or lung disease
• Have a weakened (compromised) immune system due to illness or medications
• Have open wounds or skin disease
• Are of Native American or Alaska Native descent
• Are 65 or older
• Inject drugs
• Are experiencing homelessness

Complications of scarlet fever

The bacteria that cause scarlet fever can lead to other infections and serious complications. These include:

• Abscesses (pockets of pus) around your tonsils or brain
• Arthritis or osteomyelitis
• Ear, sinus or skin infections
• Kidney damage
• Mastoiditis
• Meningitis
• Necrotizing fasciitis
• PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcus)
• Pneumonia
• Rheumatic fever
• Septicemia
• Toxic shock syndrome
• Death

How doctors diagnose scarlet fever

Healthcare providers diagnose scarlet fever by looking at the rash and performing a strep test. This means swabbing your throat with a stick that looks like a long Q-tip® to test it for bacteria.

How is scarlet fever treated?

Healthcare providers treat scarlet fever with antibiotics. These could include types of penicillin (like amoxicillin), cephalosporins or macrolides (like erythromycin, azithromycin or clindamycin). You might have to take antibiotics in pill or liquid form for about 10 days. Take the full course of medication as prescribed, even if you feel better. In some cases, you might get a single injection of antibiotics.

Recovery time

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 lymph nodes for a few weeks.

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 contact them if you or your child develops additional symptoms of scarlet fever, especially fever, a sore throat or swollen glands.

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

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

Can you prevent scarlet fever?

You can reduce the spread of the bacteria that cause scarlet fever by:

• Not sharing things like toothbrushes or eating utensils
• Washing your hands frequently
• Using an alcohol-based sanitizer if soap and water aren’t available
• Covering your mouth and nose when coughing and sneezing
• Avoiding other people if you have scarlet fever or strep throat

Is scarlet fever dangerous?

With early treatment, scarlet fever usually isn’t serious. But without treatment, the bacteria can spread to other parts of your body and cause severe complications.

Is there anything I can do to feel better?

While the antibiotics do their job, you might be able to feel better by:

• Eating soft foods and liquids, like soup, scrambled eggs or popsicles (if cold feels good on your throat)
• Gargling with salt water to help the throat pain
• Taking over-the-counter pain medications such as acetaminophen (Tylenol®) or ibuprofen (Advil®) for fever or pain (talk to your child’s pediatrician before giving them over-the-counter medications to make sure it’s safe)
• Using anti-itch skin creams, like 1% hydrocortisone cream or calamine lotion, which can help if the rash itches