Scarlet Fever

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What causes scarlet fever?

Scarlet fever is due to a throat infection caused by a bacterium (germ) called streptococcus. There are various strains (types) of streptococcus. They cause various infections, and one strain causes scarlet fever.

• Sore throat and fever (high temperature) are the typical first symptoms.
• A bright red (scarlet) rash soon develops. This is caused by a toxin (poison) that is made by the streptococcal bacteria. The toxin gets into the blood from the infected throat. The rash starts as small red spots, usually on the neck and upper chest. It soon spreads to many other parts of the body. The face may become quite flushed. The rash blanches (goes white) if you press on it.
• The tongue may become pale but coated with red spots ('strawberry tongue'). After a few days the whole tongue may look red.
• Other common symptoms include: headaches, vomiting, being off food, and feeling generally unwell.

Most children will recover fully within a week or so, even without treatment. (However, it is best to have treatment - see below.) The sore throat and fever last a few days, and then usually ease. The rash lasts about six days, and then usually fades away. As the rash fades, some of the skin may peel, mainly on the hands and feet (a bit like after being sunburnt).

Treatment is to speed recovery and to prevent possible complications.

• Antibiotics. A 10 day course of penicillin is usually advised. Other antibiotics are advised if you are allergic to penicillin. Symptoms usually go in a few days, but it is important to finish the course of antibiotics. This makes sure all the bacteria are killed and reduces the chance of complications.
• Other treatments aim to keep the child comfortable until the illness goes.
  • Paracetamol (Calpol, Disprol, etc) reduces fever and eases aches and pains. Ibuprofen is an alternative.
  • Keep the child cool. If the room is warm then take all their clothes off.
  • Give lots of cool drinks. This helps lower the fever and prevent dehydration.

Complications are uncommon, but can be serious. They include the following.

• Serious infection such as throat abscess, sinusitis, and spread of infection to the lungs which can cause pneumonia.
• Late complications sometimes develop 2-3 weeks after the infection has gone. These are rheumatic fever (which can damage the heart) and kidney damage (glomerulonephritis). These are due to immune reactions in the kidneys, heart, joints and other organs following infection with streptococcal bacteria.

Is scarlet fever infectious?

Yes. Coughing, sneezing, and breathing out the bacteria can pass it on to others. It takes 2-4 days to develop symptoms after being infected. Keep children with scarlet fever off school, and away from others, for five days after starting antibiotics.

• Scarlet fever is an infectious illness.
• Full recovery is usual.
• Serious complications are now rare, probably due to antibiotic treatment.
• Finish the full course of antibiotics, even if symptoms soon go.

© EMIS and PIP 2006   Updated: June 2006

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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