Scarlet Fever – Its Cause, Symptoms, and Treatment

Children are usually more susceptible to infectious diseases as compared to adults. Throat infections are a common health issue with children. The centers of disease control and prevention have reported that millions of children develop streptococcal throat infection annually. Although, most of the times, this infection subsides with medications; in some cases, the strains of streptococcus may develop into scarlet fever. Scarlet fever is characterized by a stellate skin rash which is bright red in color and bumpy in appearance.

Often the rash covers much of the body surface. Typically, this infection starts on the neck and face. It gradually spreads to the chest and back of the body. Clinically, the rash may be red, raised, and itchy. However,  it may change its color to white on applying pressure over the rash. While the skin rash is the most common clinical feature of scarlet fever, it may also show changes in the tongue. Let’s continue to read the article and find out more about what to look for while diagnosing scarlet fever and how to treat it.


What is scarlet fever?

Scarlet fever is a type of infection that mainly develops in people suffering from the streptococcal throat. Scarlet fever is typically characterized by a bright red rash that appears on the face and neck. With an increase in symptoms, the rash can spread to the body. (1) This infection is prevalent among children between the ages of 5-15 years.  Additionally, it is a contagious disease and spreads quickly through direct contact with infected saliva, nasal secretions,  cough, or sneeze.


The primary cause of this infection is group A streptococcus bacteria or streptococcus pyogenes bacteria. These bacteria tend to live in the mouth and nasal passages. (2) Toxins produced from these bacteria causes the typical scarlet fever rash on the body. The contagious period for scarlet fever ranges from 12 hours after the exposure to the streptococcal bacteria.

Signs and symptoms

As mentioned above, the typical characterization of scarlet fever can be done by the rash on the body. The rash usually begins to develop at least two to three days before the person experiences any systemic symptoms. It appears as a bright red, blotchy mark on the face and neck. The texture of the rash can differ from fine to rough like sandpaper.

The rash begins from the neck and spreads to the groin and underarms. With an increase in symptoms, it may further cover other body parts such as the elbows, knees, and the back. (3) As the rash subsides, about seven days, the skin around the fingers and toes may start to peel. Peeling of the skin may last for several weeks. Other common symptoms of scarlet fever may include –

  • Pastia lines – characterized as red creases in the armpits, elbow, and knees
  • Flushes face
  • Presence of white patches on the tongue with red spots – giving the appearance of a strawberry tongue
  • Sore throat with white, yellow and red patches
  • Fever above 101o F accompanied by chills
  • Swollen tonsils and glands along the neck
  • Headache
  • Nausea and vomiting
  • Pale skin around the lips

Diagnosis and treatment


Diagnosis of scarlet fever generally includes the following tests –

  • Physical examination – the doctor thoroughly examines the throat, tongue, and tonsils. Additionally, he may also check the swollen glands with characteristics of yellow and white patches. Medical history is documented to include all the symptoms of scarlet fever.
  • Throat swab – a throat swab is likely taken from the back of the child’s throat to collect a sample of the infected cells for analysis. The sample is then sent to the diagnostic lab for identification. This test is an initial confirmatory test for scarlet fever. (4)
  • Rapid Streptococcal test – this test is similar to the throat swab test. However, it is done in the office by the doctor, and the results are instant.


  • Like any other infectious disease, scarlet fever is treated with a round of antibiotics. During this time, the child is restricted to go back to school or daycare until the completion of the antibiotic course. This measure is taken to prevent the spread of disease.
  • Fever and pain are treated by acetaminophen or ibuprofen. The doctor will suggest the best suitable medication.
  • Aspirin should be avoided in children with scarlet fever as it may lead to increased chances of developing Reye’s syndrome. (5)
  • A sore throat can be treated by warm salt water gargles and warm soup.
  • Painful throat can also be treated with ice pops, ice cream and use of a cool air humidifier to maintain moisture in the throat.
  • Dehydration is one of the most common complications of scarlet fever. Make sure the child is well hydrated.
  • There is no vaccine for scarlet fever. The child may resume school after 24hours of antibiotic treatment or when the fever has completely subsided.


The best way to prevent scarlet fever is to maintain proper hygiene. Some useful preventive tips are as follows –

  • Wash your hands before and after meals
  • Follow the same rule of washing hands after using the restroom
  • Wash your hands anytime after you cough or sneeze
  • Cover your mouth and nose while coughing or sneezing
  • Do not share any utensils or drinking glasses with others

Take away message

Scarlet fever is one of the most dangerous-looking infectious diseases that commonly affects children from 5-15 years of age. Typically, this infection is characterized by a red and bumpy body rash, which gives the appearance of sandpaper. Scarlet fever is a typical outburst of the streptococcal throat. Symptoms usually include high fever, lethargy, sore throat, swollen glands, and tonsils.

Diagnosis starts with a thorough physical examination of the child. It is followed by a throat swab test or an in-office rapid streptococcal test to confirm the diagnosis. Once the diagnosis is confirmed, the child is treated with antibiotics and pain medications until the symptoms wear off.


During this time, it is essential to ensure complete hydration of the child. Additionally, sore throat mouth can be treated symptomatically. Usually, the prognosis of scarlet fever is good with early diagnosis and treatment. If you notice any such signs of scarlet fever in your child, contact your doctor immediately.


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