Scarlet Fever

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is scarlet fever?

Scarlet fever is a bacterial infection caused by the Streptococcus A group, which also causes strep throat. It used to be very common and cause serious complications, but today the infection is relatively rare.

The disease is called “scarlet fever” (or “scarlatina”) because of its characteristic red rash, which is accompanied by fever and other flu-like symptoms. The infection often occurs together with strep throat. Scarlet fever is most common in children ages 5 to 18 years.

Like most infections, scarlet fever is transmitted from person to person, through droplets of mucus and saliva. People can catch scarlet fever by touching their mouth, nose or eyes after contact with an infected person or material.

Scarlet fever is treated with antibiotics to control the infection and prevent further complications. Proper treatment can resolve the symptoms of scarlet fever; however, the rash may last several weeks before subsiding.

The symptoms of scarlet fever can become severe, particularly if untreated. Seek immediate medical care (call 911) if you, or someone you are with, have any severe symptoms, such as convulsions, difficulty breathing or rapid breathing, high fever (higher than 101 degrees Fahrenheit), loss of consciousness for even a brief moment, or seizures.

What are the symptoms of scarlet fever?

Symptoms of scarlet fever are consistent with the flu, but they are accompanied by a characteristic red rash with a sandpaper-like texture. The rash first appears on the chest and stomach, but then may spread to other parts of the body. The rash may begin either before or up to several days after the flu-like symptoms. The red color will blanch with gentle pressure. Creases around the elbows, underarms and groin may develop and appear bright red. Strep throat often occurs with this infection, as do body aches and high fever.

Common symptoms of scarlet fever

You may experience any of the following symptoms of scarlet fever:

  • Body aches
  • Enlarged lymph nodes
  • Headache
  • High fever (higher than 101 degrees Fahrenheit)
  • Nausea with or without vomiting
  • Red rash with a sandpaper-like texture
  • Sore, red throat
  • “Strawberry” (red, bumpy) tongue
  • White coating in the back of the throat

Symptoms that might indicate a serious condition

In some cases, scarlet fever can be a serious condition that should be immediately evaluated in an emergency setting. Seek immediate medical care if you, or someone you are with, have any of these serious symptoms including:

  • Convulsions
  • Difficulty breathing or rapid breathing
  • High fever (higher than 101 degrees Fahrenheit)
  • Loss of consciousness for even a brief moment
  • Nausea with or without vomiting
  • Seizures

What causes scarlet fever?

Scarlet fever is a bacterial infection caused by the group A Streptococcus bacteria that infect the nose and throat. Streptococcus group A is the same bacteria responsible for strep throat, which often occurs with the infection.

Scarlet fever is highly contagious and is transmitted through contact with an infected person. Transmission occurs via exposure to droplets of mucus or saliva from the infected person, which may be airborne, or through other accidental contact. Avoid touching your mouth, nose and eyes after contact with an infected person, and wash your hands very thoroughly.

What are the risk factors for scarlet fever?

A number of factors increase the risk of developing scarlet fever. Not all people with risk factors will get scarlet fever. Risk factors for scarlet fever include:

  • Contact with an infected person
  • Failing to wash your hands after contact with an infected person or droplets of mucus or saliva from an infected person
  • Living in a community that has experienced an outbreak
  • Touching your mouth, nose or throat after contact with an infected individual

Reducing your risk of scarlet fever

You may be able to lower your risk of scarlet fever by:

  • Avoiding contact (if possible) with a person infected with scarlet fever
  • Washing your hands thoroughly after contact with an infected person

How is scarlet fever treated?

Treatment of scarlet fever begins with seeking medical care from your health care provider. To confirm the diagnosis, your health care provider will most likely obtain a throat culture to check for the presence of Streptococcus group A bacteria. Antibiotics are the mainstay of treatment, along with bed rest and other supportive care to help reduce pain and discomfort.


With antibiotics and supportive care, most cases of scarlet fever will resolve without complications. Treatments include:

  • Antibiotics such as penicillin. Care must be taken to finish the full course of antibiotics.
  • Medications that reduce pain and fever such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol)

What you can do to improve your scarlet fever

There are several self-care measures you can take to improve your symptoms and help with recovery. These include:

  • Drinking plenty of fluids
  • Gargling with salt water for your throat
  • Getting plenty of rest
  • Using a cold compress on your head
  • Using a humidifier to relieve congestion

What are the potential complications of scarlet fever?

Rheumatic fever is an uncommon inflammatory disease that can be a complication of Streptococcus infection. This condition leads to arthritis and long-term complications in many areas of the body. In general, complications of scarlet fever, especially when treated appropriately, are rare. However, left untreated, it can lead to serious complications that include:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 15
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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  2. Scarlet fever: a group A streptococcal infection. Centers for Disease Control and Prevention.
  3. Scarlet fever. PubMed Health, a service of the NLM from the NIH.
  4. Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL (Eds), Textbook of Pediatric Infectious Diseases, 6th ed. Philadelphia: Saunders, 2009.