Scarlet fever


Scarlet fever


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.

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

Scarlet fever is extremely contagious and can be caught by:

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.

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.

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.

Scarlet fever causes a distinctive pink-red rash  


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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.


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.

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:

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.


Treating scarlet fever 

Although most cases of scarlet fever disappear in about a week without treatment, treatment is recommended.

Treatment reduces the length of time someone is contagious, speeds up recovery and reduces the risk of the complications of scarlet fever.

With treatment, most people recover in around four to five days and can return to nursery, school or work 24 hours after starting antibiotic treatment.

Without treatment, you may be contagious for two to three weeks after symptoms appear.


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 usually gets better within 24 hours of starting antibiotics, with the other symptoms disappearing within a few days. However, the whole course of treatment must be completed to ensure the infection is fully cleared.

You should 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.

Self care

Many of the symptoms of scarlet fever can be relieved using some simple self care measures, such as:

drinking plenty of cool fluids

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:

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:

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.

Scarlet fever