Topic Overview

What is scarlet fever?

Scarlet fever is a term used for strep throat with a rash. Scarlet fever is most common in children ages 2 to 10, but it can affect people of any age.

What causes scarlet fever?

Scarlet fever is caused by streptococcal (strep) bacteria, the same bacteria that cause strep throat. There are many different strains of strep bacteria, some of which cause more serious illness than others. The type of strep that infects the throat and causes scarlet fever is called group A beta-hemolytic streptococcus (GABS).

What are the symptoms?

The symptoms of scarlet fever are the same as the symptoms of strep throat (except for the rash). If you or your child has the symptoms below, call your doctor. Symptoms include:

• Fever of 38.3°C (101°F) or higher.
• Sore throat and difficulty swallowing.
• White or yellow spots or coating on the throat and tonsils.
• Swollen lymph nodes in the neck.

Other symptoms that appear before the rash, especially in children, may include general body aches, headache, stomachache, nausea, vomiting, or listlessness. Scarlet fever usually doesn't occur with cold symptoms, such as sneezing, runny or stuffy nose, or cough.

For more information on strep throat, see the topic Strep Throat.

The most noticeable symptom of scarlet fever is a rough, red rash that feels like fine sandpaper. The rash usually appears 24 hours after the fever starts. The rash begins on the chest and abdomen and then spreads over the rest of the body within 1 to 2 days. The rash and redness are more apparent in skin folds, especially in the groin, armpits, and elbow creases. It usually fades in about a week, and at that time the skin may begin to peel.

After the skin starts to peel, bright red spots may appear on the tongue, giving it an appearance called "strawberry tongue."

How is scarlet fever diagnosed?

Diagnosis of scarlet fever is usually based on a medical history, an examination of the throat, and a throat culture or rapid strep test to test for strep bacteria. One or both of these tests are needed to confirm infection with strep bacteria.

How is it treated?

Scarlet fever and the strep infection that causes it are treated with antibiotics.

What are the complications of scarlet fever?

Complications of scarlet fever include infection of the middle ear, sinusitis, and pneumonia. In rare cases, a more serious infection may develop, such as rheumatic fever or rheumatic heart disease. Most cases of scarlet fever can be cured without any permanent complications.