What Is Scarlet Fever?

Understanding the strep throat and rash of scarlet fever

Mother taking daughter's (4-6) temperature in bed, elevated view
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Scarlet fever is an illness caused by certain strains of the group A streptococci bacteria (which also causes strep throat). If you've heard frightening stories about scarlet fever, make sure to read on. While considered a devastating disease at times in the past, it is now essentially a strep throat with a rash alone. The disease is most common in children under the age of 10 but may occur at any age.


Scarlet fever usually begins with a fever and sore throat - symptoms typical of the strep throat which it is. The fever may be quite high, reaching 103 to 104 degrees F, and is frequently accompanied by nausea, vomiting, chills, headache, and abdominal pain. Coughing isn't usually a symptom of strep throat.

Without treatment, the fever may last 5 to 7 days, but usually quickly goes down within a day after starting antibiotic therapy. Around 12 to 48 hours after developing symptoms, your child will then develop a red rash. The rash is not produced by the bacteria, but rather the result of a toxin produced by some strains of group A strep.

The Scarlet Fever Rash

The red rash of scarlet fever usually consists of very small red bumps that begin on the neck and groin and then spread to the rest of the body, lasting 5 to 6 days. These bumps blanch - turn white - when you press on them vs some rashes (petechial rashes) which don't blanch with pressure.

The rash is sometimes worse on the neck, elbow creases, armpits (axilla), and groin and once the rash fades, the skin may peel, especially on the face and palms of the hands. This peeling may last up to 6 weeks.

How can you distinguish a scarlet fever rash from other rashes? There is some overlap in the characteristics of a rash with different illnesses, but signs that suggest scarlet fever include:

  • A sandpaper rash - The rash may feel like sandpaper when you rub your hand over it. This sandpaper feel is more noticeable on the arms and chest than on the face.
  • Circumoral pallor - Circumoral pallor is simply a fancy medical term which means that there is often a pale area around the mouth, despite your child's forehead and cheeks being red and flushed.
  • Pastia's lines - Another common finding in scarlet fever is of dark, hyperpigmented areas on the skin, especially in skin creases. These areas which may look the area has a suntan are called Pastia's lines.
  • Strawberry tongue - Another common finding is a red and swollen tongue. At first, the tongue usually also has a white coating on it, and with the red swollen papillae of the tongue protruding through this white coating, it gives the appearance of a strawberry tongue.

The fever and rash is usually also accompanied by a red, swollen throat and tonsils that can have a white coating of pus, swollen glands, decreased appetite, and energy level.


If scarlet fever is suspected in your child based on symptoms, your doctor will probably do a throat swab to confirm that there is infection with strep bacteria. Sometimes a throat swab is negative, but a throat culture later reveals the presence of strep.


This infection requires treatment with antibiotics, which may include penicillin, amoxicillin, erythromycin, clindamycin, or a cephalosporin.

Your child should be kept at home and away from school or friends for at least 24 hours after starting antibiotics, after which time her scarlet fever will no longer be contagious.

It is important to take a complete course of antibiotics. The strep bacteria can also rarely cause rheumatic fever, and even if her symptoms have resolved it is important to have her use the full course of treatment to prevent rheumatic fever.  Rheumatic fever is a heart disease that is not caused by the bacteria itself, but rather the body's reaction to the presence of the bacteria in the body.

Scarlet Fever and Strep Skin Infections

Although not as common, scarlet fever can also follow a strep infection of the skin. Strep is one of the bacteria which can cause the skin infection impetigo. Symptoms would be similar to the classic scarlet fever described above, but instead of a throat infection, there would be signs of a skin infection, especially around a burn or wound.

The History of Scarlet Fever

If you hear about scarlet fever from those who lived awhile back, you may be frightened, and for good reason. Scarlet fever was a bigger problem "back when." Thankfully the scarlet fever of the past was much different. Not only has the bacteria which causes scarlet fever mutated so that the infection is milder, but we now have antibiotics to easily treat this disease.

Scarlet Fever in Literature

Many people have a fear of scarlet fever based on its presence in literature. In the book The Velveteen Rabbit, it's thought that the child had scarlet fever. There are also rumors that scarlet fever caused Mary's blindness in Little House on the Prairie, but it's important to note that blindness is not a complication of scarlet fever. Going back even further, scarlet fever appeared in Little Women. Rather than scarlet fever, however, the culprit was likely rheumatic fever - a much more serious condition.


If your child has scarlet fever it is important to keep her home for 24 hours both to prevent other children from picking up the infection, but also to allow her body to rest. The disease can be transmitted by droplets, such as with a cough or a sneeze, and also by contact with surfaces that have been touched by someone with the disease.

Proper hand washing technique is very important, and though it may seem obvious, the correct way to wash hands to prevent transmission of infections such as scarlet fever is rarely practiced. Covering a cough, and refraining from sharing cups and utensils is important as well.


Centers for Disease Control and Prevention (CDC). Scarlet Fever: A Group A Streptococcal Infection. Updated 01/19/16. http://www.cdc.gov/features/scarletfever/

Ralph, A., and J. Carapetis. Group a streptococcal diseases and their global burden. Current Topics in Microbiology and Immunology. 2013. 368:1-27.