Scarlet Fever Symptoms, Diagnosis, and Treatment

Sore Throats

Scarlet fever
What is scarlet fever?. Joanne Green / Getty Images

Although it sounds like a scary diagnosis, it is important to remember that scarlet fever is basically strep throat with a rash.

Why do people get concerned when they hear the words scarlet fever? Most likely because they confuse it with rheumatic fever, a more serious complication of untreated strep throat, or they remember that people used to have serious complications from scarlet fever infections and there used to be deadly scarlet fever epidemics in the 19th and early 20th century.

Fortunately, scarlet fever is not as serious an illness anymore, both because we now have antibiotics to treat it and perhaps because the strain of bacteria that causes scarlet fever has become weaker.

Scarlet Fever Symptoms

The symptoms of scarlet fever typically include other classic strep throat symptoms, including fever, sore throat, red tonsils with pus on them, and swollen glands.

In addition, after about 24 hours, children with scarlet fever will have a red, sunburn-like, sandpapery rash all over their body, although it often starts on their neck and then spreads over their trunk, arms, and legs.

Other characteristics of scarlet fever include that:

  • the rash is usually darker in a child's flexor skin creases (Pastia lines), such as the creases of their elbows, groin, and neck
  • the area around a child's mouth is usually spared from the rash, but their cheeks may be flushed
  • the rash blanches with pressure, so for example, it disappears for a few seconds if you press down on it
  • children can have a white strawberry tongue, with a red tongue that develops a white coating on it.
  • as it goes away, the skin on a child's trunk and then hands and feet may peel

It is possible to have scarlet fever without strep throat, though, as other strep infections, including skin and wound infections, can also cause scarlet fever, as long as they are being caused by the same group A strep bacteria that causes strep throat.

If a child doesn't have any symptoms of strep throat, but it does seem like they have scarlet fever, then signs or symptoms of another source for a strep infection should be looked for.

Diagnosis of Scarlet Fever

The diagnosis of scarlet fever is usually made based on the appearance of the rash and associated symptoms of a strep infection. The presence of a strep infection can be confirmed by a rapid strep test and/or strep culture.

Scarlet Fever Treatments

The treatments for scarlet fever are the same as the treatments for strep throat and include antibiotics, such as penicillin, amoxicillin, zithromax, erythromycin, cephalosporins, and clindamycin, etc.

What You Need To Know

  • The rash of scarlet fever is caused by streptococcal pyrogenic exotoxins produced by certain strains of the group A strep bacteria that causes strep throat. Since not all strains of strep produce this exotoxin, you don't get scarlet fever every time you get strep throat.
  • The rash of scarlet fever usually lasts about 3 or 4 days.
  • Scarlet fever used to be a much more serious infection than it is today.
  • Children with scarlet fever are contagious until they have been on an antibiotic for at least 24 hours.

1Gershon: Krugman's Infectious Diseases of Children, 11th ed.

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