Scarlet fever
Introduction
Scarlet fever is a bacterial illness that causes a distinctive pink-red rash. It is uncommon in the UK
nowadays and is usually mild.
The characteristic symptom of scarlet fever is a widespread, fine pink-red rash that feels like sandpaper to touch.
It may start in one area, but soon spreads to many parts of the body, such as the ears, neck and chest. The rash
may be itchy.
Other symptoms include a high temperature, a flushed face and a red, swollen tongue.
Symptoms of scarlet fever usually develop two to five days after infection, although you will be contagious before
showing signs of the illness.
Read more about the symptoms of scarlet fever.
Scarlet fever is also known as scarlatina, although this often refers to a milder form of the disease.
It usually follows a sore throat or a skin infection (impetigo) caused by particular strains of streptococcus bacteria.
When to seek medical advice
See your GP as soon as possible if you suspect you or your child has scarlet fever.
Your GP can usually diagnose scarlet fever by looking at the characteristic rash and other symptoms, although a
sample of saliva will need to be taken from the back of the throat (throat swab) and tested in a laboratory to
confirm the diagnosis.
There's no evidence that catching scarlet fever when pregnant will put your baby at risk. However, heavily pregnant
women should tell healthcare staff if they have been in contact with someone who has scarlet fever.
How it spreads
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Scarlet fever is extremely contagious and can be caught by:
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breathing in bacteria in airborne droplets from an infected person's coughs and sneezes
touching the skin of a person with a streptococcal skin infection
sharing contaminated towels, baths, clothes or bed linen
It can also be caught from carriers - people who have the bacteria in their throat or on their skin but do not show
any symptoms.
Who is affected
Anybody can catch scarlet fever, but it usually affects children aged two to eight years old. As it is so contagious,
scarlet fever is likely to affect someone in close contact with a person with a sore throat or skin infection caused
by streptococcus bacteria. It may also affect someone who lives in a crowded environment, such as day care.
Between 2,000 and 4,000 cases of scarlet fever are diagnosed each year in England.
You will only develop the symptoms of scarlet fever if you're susceptible to toxins produced by the streptococcus
bacteria. Most children over 10 will have developed immunity to the toxins from streptococcal bacteria.
It is possible to catch scarlet fever more than once, although this is rare.
How it is treated
Scarlet fever used to be a very serious disease, but most cases today are mild. This is because scarlet fever can
easily be treated with antibiotic tablets. These must be taken for 10 days, even though most people recover after
four to five days.
With proper treatment, further problems are very unlikely. However, there is a small risk of the infection spreading
to other parts of the body, such as the ear, sinuses and lungs.
Read more about treating scarlet fever and the complications of scarlet fever.
Preventing it from spreading
If your child has scarlet fever, do not let them go to school and keep them away from other people until they have
been on a course of antibiotics for at least 24 hours.
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NHS Choices has been developed to help you make choices about your health, from lifestyle decisions about
things like smoking, drinking and exercise, through to the practical aspects of finding and using NHS services
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All tissues and cloths that someone with scarlet fever has coughed or sneezed into should be washed or disposed
of immediately. Wash your hands thoroughly with soap and water if you have touched any of these.
Avoid sharing contaminated eating utensils, cups and glasses, clothes, baths, bed linen or towels.
Read more about how to prevent germs from spreading.
Scarlet fever causes a distinctive pink-red rash
Symptoms of scarlet fever
Symptoms of scarlet fever generally take two to five days to appear after infection.
The illness often starts with a sore throat, headache and a high temperature (fever), with a rash developing 12 to
48 hours later.
Rash
Red blotches are the first sign of the rash. These turn into a fine pink-red rash that feels like sandpaper to touch
and looks like sunburn.
The rash usually starts in one place, but soon spreads to other parts of the body. It commonly affects the ears,
neck, chest, elbows, inner thighs and groin, and may be itchy.
It does not normally spread to the face. However, the cheeks become flushed and the area just around the mouth
stays quite pale. The rash will turn white if you press a glass on it.
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The rash usually fades after about a week, but the outer layers of skin, usually on the hands and feet, may peel for
several weeks afterwards.
In milder cases, sometimes called scarlatina, the rash may be the only symptom.
Other symptoms
Other symptoms may include:
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swollen neck glands
loss of appetite
nausea or vomiting
red lines in the folds of the body, such as the armpit, which may last a couple of days after the rash has gone
a white coating on the tongue, which peels a few days later leaving the tongue red and swollen (this is known
as strawberry tongue)
a general feeling of being unwell
When to seek medical advice
See your GP as soon as possible if you suspect you or your child has scarlet fever.
Chickenpox and scarlet fever
If your child has chickenpox and develops a rash that looks like scarlet fever, it may be a sign of a secondary
bacterial infection.
In these cases, you should seek immediate medical advice to reduce the risk of potentially serious complications.
Treating scarlet fever
Although most cases of scarlet fever go away in about a week without treatment, treatment is
recommended.
This is because treatment reduces the length of time you are contagious, speeds up recovery and reduces the
risk of complications from scarlet fever.
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With treatment, most people recover in around four to five days and can return to work or school after 24 hours.
You may be contagious for two to five weeks without treatment.
Antibiotics
Scarlet fever is treated with a 10-day course of antibiotics. This will usually be penicillin tablets, although syrup
may be used for young children. For people who are allergic to penicillin, alternative antibiotics like erythromycin
can be used instead.
The fever will normally disappear within 24 hours of starting antibiotics and the other symptoms usually go within a
few days. However, the whole course of treatment must be finished to make sure the infection is fully cleared.
Stay at home for at least 24 hours after you start treatment.
Looking after yourself at home
You can help relieve many of the symptoms of scarlet fever with some simple self-care measures, such as:
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drinking plenty of cool fluids or eating soft foods if your throat is painful
taking paracetamol to bring down a high temperature
using calamine lotion or antihistamine tablets to relieve itching
Complications of scarlet fever
Most cases of scarlet fever cause no complications, especially if the condition is properly treated.
In the early stages, there is a small risk of:
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an ear infection
a throat abscess (painful collection of pus)
sinusitis (inflammation of the sinuses)
pneumonia (inflammation of the lungs)
meningitis (inflammation of the membranes surrounding the brain and spinal cord)
Very rare complications that can occur at a later stage include:
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NHS Choices has been developed to help you make choices about your health, from lifestyle decisions about
things like smoking, drinking and exercise, through to the practical aspects of finding and using NHS services
when you need them.
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rheumatic fever, which can cause pain in the joints, chest pain and shortness of breath
glomerulonephritis (damage to the tiny filters inside your kidneys)
liver damage
osteomyelitis (infection of the bone)
blood poisoning
necrotising fasciitis (a flesh-eating disease)
toxic shock syndrome (a rare, life-threatening bacterial infection)
You may have one of these rare complications if you are very unwell, in severe pain and have severe headache,
vomiting or diarrhoea. See your GP immediately if any of these symptoms appear in the first few weeks after the
main infection has cleared up.
Can I get scarlet fever again?
One episode of scarlet fever usually makes you immune to further infection. However, recurring attacks happen in
rare cases.
NHS Choices puts you in control of your healthcare
NHS Choices has been developed to help you make choices about your health, from lifestyle decisions about
things like smoking, drinking and exercise, through to the practical aspects of finding and using NHS services
when you need them.
www.nhs.uk