Scarlet fever is a bacterial illness that mainly affects children. It causes a distinctive pink-red rash.
The illness is caused by Streptococcus pyogenes bacteria, also known as Group A Streptococcus, which are found on the skin and in the throat.
Scarlet fever usually follows a sore throat or a skin infection, like impetigo, caused by particular strains of Streptococcus bacteria.
The symptoms of scarlet fever usually develop 2 to 5 days after infection. However, the incubation period (the period between exposure to the infection and symptoms appearing) can be as short as one day or as long as 7 days.
You or your child:
The distinctive pink-red rash caused by scarlet fever develops 12 to 48 hours after symptoms like a sore throat or headache.
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. It may also be itchy.
On darker skin the rash may be more difficult to see although its rough texture should be apparent.
The rash usually starts on the chest and stomach, but soon spreads to other parts of the body, like the:
The rash doesn’t usually 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.
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 of scarlet fever may include:
If you think you or your child may have scarlet fever, see your GP for a proper diagnosis and appropriate treatment. It usually clears up after about a week
Your GP should be able to diagnose scarlet fever by examining the distinctive rash and asking about other symptoms. They may also decide to take a sample of saliva from the back of the throat so it can be tested in a laboratory to confirm the diagnosis.
There’s no evidence to suggest that catching scarlet fever when pregnant will put your baby at risk. However, if you’re heavily pregnant, tell the doctors and midwives in charge of your care if you’ve been in contact with someone who has scarlet fever.
Scarlet fever is very infectious and can be caught by:
It can also be caught from people who have the bacteria in their throat or on their skin but don’t have any symptoms.
Most cases of scarlet fever occur in children under 10 (usually between 2 and 8 years of age). However, people of any age can get the illness.
As it’s easily spread, scarlet fever is likely to affect someone in close contact with a person with a sore throat or skin infection caused by Streptococcus bacteria. Outbreaks can occur in nurseries and schools where children are in close contact with one another.
The symptoms of scarlet fever will only develop in people susceptible to toxins produced by the Streptococcus bacteria. Most children over 10 years of age will have developed immunity to these toxins.
It’s possible to have scarlet fever more than once, but this is rare.
Most cases of scarlet fever clear up after about a week without treatment. However, your GP may recommend treatment as it:
With treatment, most people recover in about 4 to 5 days and can return to nursery, school or work 24 hours after starting antibiotic treatment.
Without treatment, you’ll be infectious for 1 to 2 weeks after symptoms appear.
Scarlet fever is usually treated with a 10-day course of antibiotics. This is often in the form of penicillin or amoxicillin tablets, although liquid may be used for young children.
For people who are allergic to penicillin, alternative antibiotics like erythromycin can be used instead.
The symptoms usually improve within 24 hours of starting antibiotics, with the other symptoms disappearing within a few days. However, it’s important that the whole course of treatment is completed to ensure the infection is fully cleared and reduce the potential for antibiotic resistance.
Keep your child away from nursery or school for at least 24 hours after starting antibiotic treatment.
Adults with scarlet fever should also stay off work for at least 24 hours after starting treatment.
Many of the symptoms of scarlet fever can be relieved using some simple self care measures.
Most cases of scarlet fever don’t cause complications, particularly if the condition is properly treated.
However, there’s a small risk of the infection spreading to other parts of the body and causing more serious infections, like:
Very rare complications that can occur at a later stage include:
There’s currently no vaccine for scarlet fever.
If your child has scarlet fever, keep them away from nursery or school for at least 24 hours after starting treatment with antibiotics. Adults with the illness should also stay off work for at least 24 hours after starting treatment.
GPs, schools and nurseries should be aware of the current high levels of scarlet fever and inform local health protection teams if they become aware of cases, particularly if more than one child is affected.
Last updated:
24 August 2023