What to Know About Scarlet Fever

Find out what scarlet fever looks like and how it differs from strep throat

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Scarlet fever is an infection caused by group A streptococcus (group A strep), the same bacteria responsible for strep throat. It is also known as scarlatina.

Unlike strep throat, people with scarlet fever develop a rash and a red tongue. Scarlet fever is most likely to affect children between ages 5 and 15 and rarely, if ever, sickens adults. Although once a dangerous disease of childhood, scarlet fever is now highly treatable and uncommon in most of the world.

This article discusses scarlet fever and its symptoms, causes, diagnosis, and treatment.

What is Scarlet Fever?
Verywell / Emily Roberts

Scarlet Fever vs. Strep Throat

Scarlet fever is caused by the same bacteria that causes strep throat. The two conditions are similar but with one important distinction: Besides typical strep throat symptoms, children with scarlet fever will also develop a rash and a bright red tongue.

Strep throat does not always develop into scarlet fever. Although it looks worse than strep throat, scarlet fever is no more serious as long as it is treated.

Scarlet Fever Symptoms

Like strep throat, scarlet fever begins with the following symptoms:

  • Fever
  • Sore throat
  • Headache
  • Chills

A day or two after these symptoms begin, children with scarlet fever also develop a reddish, sandpapery rash. The rash persists for some time after the initial symptoms of scarlet fever respond to treatment. Sometimes the skin on certain areas of the body will peel for a few weeks. 

Although not common, scarlet fever can develop after a strep infection of the skin such as impetigo. Rather than beginning as a throat infection, this type of scarlet fever would begin with signs of infection around a burn or wound.

In very rare cases, scarlet fever can lead to serious long-term health issues, including rheumatic fever and kidney problems. But such complications are highly unusual and easily prevented by treating scarlet fever (and other strep infections) promptly with a full course of antibiotics.

What Causes Scarlet Fever?

Group A strep bacteria are responsible for many types of infections, including strep throat and certain skin infections. The bacteria that belong to the strain of group A strep that causes scarlet fever produce a toxin that's responsible for the red rash and "strawberry tongue" which are unique characteristics of the illness.

You can contract the Group A strep bacteria through close contact with someone who has it. The bacteria can also travel via droplets of infected fluid that become airborne when an infected person coughs or sneezes. Touching something that the bacteria have landed on and then touching your mouth, eyes, or nose can cause you to become infected.

The disease spreads more in crowded conditions. Hand washing and covering coughs and sneezes can help prevent spread. A child is still infectious until after two days of antibiotics.

How Scarlet Fever Is Diagnosed

Scarlet fever is diagnosed in the same way as strep throat. A throat swab is taken and either a rapid strep test is performed or the sample is cultured to see if the streptococcus bacteria is present. The rapid test can show a positive result within five to 10 minutes, but the results from a culture may take up to two days. Both tests will often be performed because the rapid tests can be unreliable.


There are two important aspects of treating scarlet fever: killing the bacteria with a full course of antibiotics and easing symptoms.

A full course of antibiotic treatment is vital. The antibiotics used most often are penicillin and amoxicillin. For people who are allergic to penicillin, there are plenty of safe alternatives. 

For dealing with the uncomfortable and sometimes painful symptoms of scarlet fever, there are a variety of home remedies and over-the-counter (OTC) remedies. These include simple approaches to easing a sore throat such as eating cold foods, drinking warm liquids, and using a humidifier to keep the air moist. Non-steroidal anti-inflammatory drugs (NSAIDs) can bring down fever and ease general body aches and pains. 

How to Prevent Scarlet Fever

Scarlet fever and the bacteria that causes it are contagious, and children who have the condition should stay home from school until 48 hours after beginning antibiotic treatment. Untreated scarlet fever can be spread for a few weeks after symptoms begin.

You can avoid becoming exposed to group A strep by not coming into contact with infected people until they've been taking antibiotics for at least two days. If you share a home with someone who has scarlet fever, clean and disinfect surfaces regularly to avoid spreading the bacteria throughout the household

Raw, unpasteurized milk can contain dangerous bacteria, including group A strep. Avoid drinking raw milk or eating unpasteurized dairy products.


Scarlet fever is a childhood disease caused by group A strep, the same bacteria that causes strep throat. Once a dangerous disease, today it is easily treatable with antibiotics.

People with scarlet fever have the same symptoms as people with strep throat, but they also develop a reddish, sandpapery rash and a bright red tongue.

The condition is usually diagnosed with a throat swab. If your child has scarlet fever, it's important that they take the full course of antibiotics prescribed by their healthcare provider. This will help clear the bacteria so they can return to school sooner.

1 Source
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  1. Centers for Disease Control and Prevention. Scarlet fever: All you need to know.

Additional Reading

By Megan Coffee, MD
Megan Coffee, MD, PhD, is a clinician specializing in infectious disease research and an attending clinical assistant professor of medicine.