The red rash of scarlet fever usually begins on the face or neck, later spreading to the chest, trunk, arms and legs.
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.
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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. Pushing on the reddened skin makes it turn pale.
- Red lines. The folds of skin around the groin, armpits, elbows, knees and neck usually become a deeper red than the other areas with the 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.
Signs and symptoms of scarlet fever also include:
- Fever of 100.4 F (38.0 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
- Belly (abdominal) pain
- Headache and body aches
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:
- A fever of 100.4 F (38.0 C) or higher
- Swollen or tender glands in the neck
- A red rash
Signs and symptoms that need emergency evaluation
In children and teens, any of the following symptoms need emergency evaluation:
- New shortness of breath at rest
- Trouble breathing (grunting, pulling-in chest muscles between the ribs, nostril flaring)
- Noisy, wheezy or raspy breathing that does not clear with coughing
- Rapid breathing
- Chest pain
- Inability to swallow liquids or saliva, muffled voice, or inability to open mouth fully
- Confusion, lack of energy, or inability to stay alert and awake
- Dizziness when sitting or standing
- Drooling (if age 3 years or older)
- Persistent or severe vomiting or diarrhea
For infants less than 2 months old, additional symptoms needing emergency evaluation include:
- Inability to be comforted
- Breathing that repeatedly starts and stops
- Temperature less than 96.0 F (35.5 C) or greater than 100.4 F (38 C)
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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.
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:
- Middle ear
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:
- Wash your hands. Show your child how to wash hands thoroughly with warm soapy water for at least 20 seconds. Alcohol-based hand sanitizer can be used if soap and water are not available.
- 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 the mouth and nose when coughing and sneezing to prevent the potential spread of germs.
If your child has scarlet fever, wash drinking glasses and utensils in hot soapy water or in a dishwasher after your child uses them.