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Scarlet fever

Medically reviewed by Last updated on Jun 7, 2022.


Scarlet fever is a bacterial illness that develops in some people who have strep throat. Also known as scarlatina, scarlet fever features a bright red rash that covers most of the body. Scarlet fever almost always includes a sore throat and a high fever.

Scarlet fever is most common in children 5 to 15 years of age. Although scarlet fever was once considered a serious childhood illness, antibiotic treatments have made it less threatening. Still, if left untreated, scarlet fever can result in more-serious conditions that affect the heart, kidneys and other parts of the body.

Scarlet fever

The red rash of scarlet fever usually begins on the face or neck, later spreading to the chest, trunk, arms and legs.


The signs and symptoms that give scarlet fever its name include:

Signs and symptoms of scarlet fever also include:

The rash and the redness in the face and tongue usually last about a week. After these signs and symptoms have gone away, the skin affected by the rash often peels.

When to see a doctor

Talk to your health care provider if your child has a sore throat with:

Signs and symptoms that need emergency evaluation

In children and teens, any of the following symptoms need emergency evaluation:

For infants less than 2 months old, additional symptoms needing emergency evaluation include:


Scarlet fever is caused by the same type of bacteria that causes strep throat — group A streptococcus (strep-toe-KOK-us), also called group A strep. In scarlet fever, the bacteria release a toxin that produces the rash and red tongue.

The infection spreads from person to person by droplets released when an infected person coughs or sneezes. The incubation period — the time between exposure and illness — is usually 2 to 4 days.

Risk factors

Children 5 to 15 years of age are more likely than are other people to get scarlet fever. Scarlet fever germs spread more easily among people in close contact, such as family members, child-care groups or classmates.

Scarlet fever most often occurs after a strep throat infection. Sometimes scarlet fever may occur after a skin infection, such as impetigo. People can get scarlet fever more than once.


If scarlet fever goes untreated, the bacteria may spread to the:

Rarely, scarlet fever can lead to rheumatic fever, a serious inflammatory disease that can affect the heart, joints, nervous system and skin.

A possible relationship has been suggested between strep infection and a rare condition called pediatric autoimmune neuropsychiatric disorder associated with group A streptococci (PANDAS). Children with this condition experience worsened symptoms of neuropsychiatric conditions, such as obsessive-compulsive disorder or tic disorders, with strep. This relationship currently remains unproved and controversial.


There is no vaccine to prevent scarlet fever. The best ways to prevent scarlet fever are the same as the standard precautions against infections:

If your child has scarlet fever, wash drinking glasses and utensils in hot soapy water or in a dishwasher after your child uses them.


During the physical exam, your health care provider will:

Throat swab

If your health care provider suspects strep is the cause of your child's illness, your provider will swab the tonsils and back of your child's throat to collect material that may have the strep bacteria.

A rapid strep test can identify the bacteria quickly, usually during your child's appointment. If the rapid test is negative, but your health care provider still thinks strep bacteria is the cause of your child's illness, a strep throat culture can be done. It can take longer to get the results of this test.

Tests for the strep bacteria are important because a number of conditions can cause the signs and symptoms of scarlet fever, and these illnesses may require different treatments. If there are no strep bacteria, then some other factor is causing the illness.


For scarlet fever, your health care provider will prescribe an antibiotic. Make sure your child takes all of the medication as directed. If your child doesn't follow the treatment guidelines, treatment may not completely eliminate the infection, which can increase your child's risk of developing complications.

Use ibuprofen (Advil, Children's Motrin, others) or acetaminophen (Tylenol, others) to control the fever and minimize throat pain. Check with your child's health care provider about the right dosage.

Your child can return to school after having taken antibiotics for at least 12 hours and no longer having a fever.

Self care

During scarlet fever, you can take several steps to reduce your child's discomfort and pain.

Preparing for your appointment

You're likely to first see your family health care provider or your child's pediatrician. However, when you call to set up your appointment, you may be urged to seek immediate medical care.

What you can do

Before your appointment, you might want to make a list of questions for the health care provider. These may include:

Don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions. Your provider may ask:

Being ready to answer questions may reserve time to go over any points you want to talk about in-depth.

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