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Scarlet Fever

What is scarlet fever?

Scarlet fever is an infection caused by a strain of the bacteria (germ) called Group A Beta-haemolytic Streptococcus (GABS), or strep. This germ may make a substance called a toxin to which some people are sensitive. Not all GABS makes this toxin and only some people are sensitive to it.

Scarlet fever
Scarlet fever rash on body 
The scarlet fever rash looks like red, sunburned skin. It is made up of tiny pink spots.

The main symptom of the infection is a scarlet (red-to-orange) rash that spreads along your child’s skin. Scarlet fever is rare in children younger than 2 years. It is most frequent in children aged 4 to 8 years.

Signs and symptoms of scarlet fever


The rash is the most striking sign of scarlet fever. It usually begins looking like a sunburn that feels rough, like sandpaper, and may itch. The rash often appears first on the neck and face. Then it spreads to the chest and back, and finally to the rest of the body. It tends to form red streaks in body creases, especially around the underarms and elbows. After 4 to 6 days the rash usually fades. The affected skin may start to peel 7 to 10 days after the rash goes away and may continue to peel for up to 6 weeks.

Scarlet fever on the elbow
Scarlet fever rash on arm, in elbow crease 
Scarlet fever can the elbow creases and other skin folds, to become very red.


The fever may be high. Often, the fever appears 12 to 48 hours before the rash.

Sore throat

If you look into your child’s mouth, you may see enlarged red tonsils, sometimes covered with a white-yellow membrane or coating. The tongue may be white-red with small red dots and look like a strawberry.

Other symptoms

Some children may have other symptoms like headache, nausea, vomiting, stomach-area pain, and muscle pain.

Not all cases of this condition look the same and many conditions can look similar. For information about your child’s illness, please speak to your child’s doctor.

Other infectious conditions (such as measles or staphylococcal skin infection) or inflammatory conditions (such as Kawasaki disease) can cause similar symptoms to scarlet fever.

What can doctors do for scarlet fever?

Throat swab or blood tests

To find out the cause of your child’s pain and rash, the doctor will take a throat swab. A throat swab is a cotton-tipped stick that the doctor wipes along the side and back of your child’s throat. The swab is then tested for the strep germ.

Sometimes blood tests may be needed in order to tell scarlet fever apart from other conditions.


If the throat swab has the strep germ, the doctor will prescribe your child with oral (by mouth) antibiotics or an antibiotic injection.

A long-acting penicillin injection can be given if your child will not take oral medicines or if you will not be able to give the medicine regularly. If given correctly, the oral antibiotic works just as fast and effectively as the injection.

Taking care of your child at home

Monitor the fever and complete the antibiotics

The fever and the throat pain usually resolve 48 hours after starting the antibiotic therapy. It is important to complete the 10 days of antibiotic therapy in order to prevent recurrence, antibiotic resistance, and complications of the disease.

Acetaminophen (Tylenol, Tempra, or other brands) or ibuprofen (Motrin, Advil, or other brands) can be used to treat the fever or throat pain. DO NOT give your child ASA​ (acetylsalicylic acid or Aspirin).

Sore throat

Eating and drinking may be painful for your child. Make sure she drinks enough fluids. Try to make eating and drinking easy for your child. Some helpful foods include:

  • warm (not too hot) caffeine-free soothing teas
  • warm (not too hot) healthy soups
  • ice cubes, frozen juice, or popsicles to suck on
  • cold drinks with a straw; it is easier to drink that way
  • blended fruit and yoghurt smoothies
  • frozen foods like ice cream or milkshakes

Soothing the rash

Use non-perfumed creams to soothe the skin. Oatmeal, or commercial oatmeal bathing powders, in the bath may also lessen the redness and discomfort.

How to prevent spreading the infection

The rash itself is not contagious. Still, scarlet fever can spread easily to family members and your child’s classmates. Any child or adult who lives in your home and has similar symptoms in the week after exposure should have a throat swab.

Your child is no longer contagious after she has been on an antibiotic for 24 hours. That means your child can return to school after 1 day if she is feeling better. Other tips to prevent spreading the infection:

  • Wash hands with warm soapy water.
  • Do not share drinking glasses or eating utensils with friends or classmates.
  • Be sure to wash your child's dining utensils and drinking glasses in hot soapy water or a dishwasher.
  • Sneeze into your elbow or cover your mouth and nose when coughing.

When to get medical assistance

Call your child’s regular doctor if:

  • the fever does not go away 48 hours after starting antibiotics
  • the rash develops blisters or open sores, or becomes quite painful
  • your child is unable to drink or eat and is becoming dehydrated
  • your child has a lot of vomiting
  • your child has difficulty breathing
  • your child appears very sick

Key points

  • The main symptoms of scarlet fever are fever, a rough red rash, and sore throat.
  • If you suspect that your child might have scarlet fever, take her to your doctor right away.
  • Finishing the full antibiotic treatment is crucial to prevent relapse and complications.
  • Use soft foods and cold drinks as well as medicines such as Tylenol, Advil, or other brands to reduce the pain.
  • Make sure that any other family members or close contacts that have similar symptoms see their primary care health care provider.

Ehud Rosenbloom, MD
Janine Flanagan, MD, FRCPC
Bruce G. Minnes, MD, FRCPC, ABPEM