Overview

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 is almost always accompanied by 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.

Symptoms

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

  • Red rash. The rash looks like a sunburn and feels like sandpaper. It typically begins on the face or neck and spreads to the trunk, arms and legs. If pressure is applied to the reddened skin, it will turn pale.
  • Red lines. The folds of skin around the groin, armpits, elbows, knees and neck usually become a deeper red than the surrounding rash.
  • Flushed face. The face may appear flushed with a pale ring around the mouth.
  • Strawberry tongue. The tongue generally looks red and bumpy, and it's often covered with a white coating early in the disease.

The rash and the redness in the face and tongue usually last about a week. After these signs and symptoms have subsided, the skin affected by the rash often peels. Other signs and symptoms associated with scarlet fever include:

  • Fever of 101 F (38.3 C) or higher, often with chills
  • Very sore and red throat, sometimes with white or yellowish patches
  • Difficulty swallowing
  • Enlarged glands in the neck (lymph nodes) that are tender to the touch
  • Nausea or vomiting
  • Headache

When to see a doctor

Talk to your doctor if your child has a sore throat with:

  • A fever of 102 F (38.9 C) or higher
  • Swollen or tender glands in the neck
  • A red rash

Causes

Scarlet fever is caused by the same type of bacteria that cause strep throat. In scarlet fever, the bacteria release a toxin that produces the rash and red tongue.

The infection spreads from person to person via droplets expelled when an infected person coughs or sneezes. The incubation period — the time between exposure and illness — is usually two to four 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 or classmates.

Complications

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

  • Tonsils
  • Lungs
  • Skin
  • Kidneys
  • Blood
  • Middle ear

Rarely, scarlet fever can lead to rheumatic fever, a serious condition that can affect the:

  • Heart
  • Joints
  • Nervous system
  • Skin

Prevention

The best prevention strategies for scarlet fever are the same as the standard precautions against infections:

  • Wash your hands. Show your child how to wash his or her hands thoroughly with warm soapy water.
  • Don't share dining utensils or food. As a rule, your child shouldn't share drinking glasses or eating utensils with friends or classmates. This rule applies to sharing food, too.
  • Cover your mouth and nose. Tell your child to cover his or her mouth and nose when coughing and sneezing to prevent the potential spread of germs.

If your child has scarlet fever, wash his or her drinking glasses, utensils and, if possible, toys in hot soapy water or in a dishwasher.

March 13, 2014
References
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  3. Gibofsky A, et al. Epidemiology and pathogenesis of acute rheumatic fever. http://www.uptodate.com/home. Accessed Oct. 22, 2013.
  4. Wessels MR. Streptococcal pharyngitis. New England Journal of Medicine. 2011;364:648.
  5. Van Driel ML, et al. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004406.pub3/abstract. Accessed Oct. 22, 2013.
  6. Get smart: Symptom relief. Centers for Disease Control and Prevention. http://www.cdc.gov/getsmart/antibiotic-use/symptom-relief.html. Accessed Oct. 22, 2013.