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Scarlet Fever

Scarlet fever is an infection caused by a strain of the bacteria called Group A Beta-haemolytic Streptococcus (GABS), or strep for short. This strain of bacteria produces a toxin (a harmful substance) that causes the scarlet rash. However, not all strains of bacteria produce this toxin.

Scarlet fever occurs most often in children aged four to eight. It is rare in children younger than two years.

Signs and symptoms of scarlet fever

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 a scarlet fever infection is a scarlet (red-to-orange) rash that spreads along your child’s skin.

  • The rash often appears first on the neck and face.
  • It begins by looking like a sunburn. It can feel rough, like sandpaper, and may itch.
  • After it appears on the neck and face, the rash spreads to the chest and back and then the rest of the body.
  • It tends to form red streaks in body creases, especially around the underarms and elbows.
  • It usually fades after four to six days.

​Skin peeling

The affected skin may start to peel seven to 10 days after the rash disappears and may continue to peel for up to six weeks.

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


Often, a fever appears one to four days 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 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.

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

​How scarlet fever is diagnosed

To find out the cause of your child’s pain and rash, the doctor may 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 GABS or strep bacteria.

​How scarlet fever is treated

If the throat swab is positive for GABS, the doctor will prescribe oral antibiotics (taken by mouth) for your child.

​Taking care of your child at home

Monitor the fever and complete the antibiotics

The fever and the throat pain usually resolve within three days of your child starting antibiotics. It is important to complete the course of antibiotics, even when your child starts to feel better. Doing so prevents antibiotic resistance and prevents scarlet fever from returning or developing complications.

You can use acetaminophen or ibuprofen​ to treat the fever or throat pain. You should not give ASA (acetylsalicylic acid) to children.

Ease your child’s sore throat

Eating and drinking may be painful for a child with a sore throat. Here are some tips to make it easier.

  • If your child is having trouble swallowing, give soft foods that are easy to swallow, such as soups, ice cream, pudding or yoghurt.
  • Give plenty of liquids. Sipping with a straw or sippy cup may help.
  • If your child is more than one year old, try giving 1 to 2 teaspoons (5 to 10 mL) of pasteurized honey to soothe the throat and ease the cough.
  • Offer older children warm salt water for gargling.

Ice cubes and lozenges may provide some relief for older children or teens, but do not give them to younger children because they are a choking hazard.

​Soothing the rash

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

​How to prevent scarlet fever from spreading

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

Your child is no longer contagious after they have been on antibiotics for 24 hours. That means your child can return to school after one day if they are feeling better.

Other tips to prevent spreading the infection include:

  • washing hands with warm soapy water
  • not sharing drinking glasses or eating utensils with friends or classmates
  • washing your child's dining utensils and drinking glasses in hot soapy water or a dishwasher
  • sneezing into the elbow or covering the mouth and nose when coughing.

​Complications from scarlet fever

Although rare, one complication of scarlet fever is rheumatic fever, a condition that can involve the skin, joints, heart and brain. Treating the initial strep infection with antibiotics almost always prevents rheumatic fever.

Other complications can include joint inflammation (arthritis) and kidney inflammation.

When to see a doctor

Call your child’s doctor if:

  • the fever does not go away three days 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 difficulty breathing

​Key points

  • The main symptoms of scarlet fever are fever and a rough red rash. Your child may also have a sore throat.
  • If you suspect that your child might have scarlet fever, go to see your child’s health care provider.
  • Scarlet fever is treated with antibiotics. It is very important to finish the antibiotics to prevent repeat infections and complications.
  • Use soft foods and cold drinks as well as pain medications to reduce the pain.
  • Make sure that any other family members or close contacts with similar symptoms see their health care provider.

Shawna Silver, MD, FRCPC, FAAP, PEng​