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Scarlet fever

Medically reviewed by Last updated on Nov 20, 2023.

What is Scarlet fever?

Harvard Health Publishing

Scarlet fever is an infection caused by Group A Streptococcus (andquot;strep") bacteria. It causes a finely textured rash that can appear like sandpaper along with other symptoms. It usually occurs after a strep infection of the throat (strep pharyngitis, or strep throat), but occasionally after a strep skin infection. The rash of scarlet fever is caused by a toxin that the strep bacteria produce.

Scarlet fever once was common among children ages 2 to 10, but now it is relatively rare. The reason for this remains a mystery, especially because there has been no decrease in the number of cases of strep throat or strep skin infections.


Scarlet fever usually is triggered by a strep throat infection, which causes the following symptoms:

Within 12 to 48 hours after these symptoms appear, the typical scarlet fever rash begins.

The scarlet fever rash is as bright red as sunburn, and it often has a fine texture like sandpaper (andquot;sandpaper rash") or gooseflesh (goosebumps). It usually starts in the underarm area, groin and neck, then spreads to the trunk, back, arms and legs. Other symptoms of scarlet fever include:

Occasionally, scarlet fever follows a streptococcal skin infection, such as an infection of burns or wounds, or impetigo. When this happens, the rash and related skin symptoms appear, but there are no symptoms related to strep throat.


Your doctor will suspect scarlet fever based on the appearance of your rash and its timing in relation to other symptoms. During the physical examination, your doctor will check for the symptoms of scarlet fever. To confirm the diagnosis of a strep infection, your doctor will take a swab of throat secretions. If no sore throat is present, then the exam will focus on other possible sources of strep infection, such as impetigo.

Expected duration

Although the scarlet fever rash generally fades after 6 to 7 days, it is followed by a period of skin flaking and peeling that lasts for 10 to 14 days. Occasionally, in patients with severe rash, peeling and flaking may persist for a few weeks.


The best prevention is thorough hand washing, especially by those who have a sore throat or other symptoms of strep infection. If you live with someone who has a strep infection, and you develop a sore throat or fever, make an appointment with a health care professional.


Scarlet fever is treated with antibiotics, usually penicillin or azithromycin. However, other antibiotics may be effective as well.

In addition to antibiotic treatment, patients with scarlet fever and severe throat symptoms may try:

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

View more treatment options

When to call a professional

Call your doctor promptly whenever you or someone in your family develops a rash that is accompanied by fever or other symptoms of infection.


In most cases, all signs of the scarlet fever rash are gone within two weeks, and there is no long-term scarring. However, because scarlet fever is a strep infection, patients with this illness have the same risk of strep complications (otitis media, pneumonia, rheumatic fever, glomerulonephritis, etc.) as patients without a rash.

Additional info

Centers for Disease Control and Prevention (CDC)

Learn more about Scarlet fever

Treatment options

Care guides

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.