Scarlet fever

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Scarlet fever is a bacterial infection that mainly affects children. It usually causes a typical rash, fever and a sore throat.

Thanks to antibiotics like penicillin, scarlet fever is easy to treat. Antibiotics can also reduce the time during which children with scarlet fever are contagious. The infection is spread through bacteria-containing droplets and close physical contact.

Before the development of penicillin, scarlet fever sometimes led to serious complications. But it’s usually quite a mild illness nowadays. It’s still important to try to stop it from spreading to other people, though. One thing you can do is wash your hands often.

Unlike with many other childhood diseases, having had scarlet fever in the past doesn't make you immune to future scarlet fever infections. So people can have it more than once in their lives.


The symptoms usually start one to three days after infection. Scarlet fever may cause the following symptoms:

Sore throat

Fever and chills

Painful swallowing




Swollen tonsils

Swollen lymph nodes

Stomach ache (common in younger children)

A red tongue is also typical of scarlet fever – it is sometimes referred to as a “strawberry tongue.”

A rash that doesn’t itch usually starts breaking out two days after infection. The rash consists of many small spots that turn from pink to red. It feels rough, like sandpaper. It may spread from the torso to the neck and then the hands and feet within a few days. But it usually doesn’t affect the skin below the nose and around the mouth, or the palms of your hands or soles of your feet. The rash is often especially visible in the groin and armpit area. The spots disappear after about a week. In the second, third and fourth weeks the skin starts to flake off, especially on the palms of the hands and fingertips and on the soles of the feet and the tips of the toes.

Sometimes the symptoms of scarlet fever are quite mild, and may only include a bit of a sore throat, a moderate temperature and mild rash. But sometimes people develop a severe sore throat, high temperature and a worse rash.


Scarlet fever is caused by the same type of bacteria that causes strep throat — group A streptococcus (strep-toe-KOK-us), also called group A strep. In scarlet fever, the bacteria release a toxin that produces the rash and red tongue.

The infection spreads from person to person by droplets released when an infected person coughs or sneezes. The incubation period — the time between exposure and illness — is usually 2 to 4 days.

Risk factors

It is rare in children younger than 3 years of age. The most common risk factor is close contact with another person with scarlet fever. Crowding, such as found in schools, military training facilities, and daycare centers, increases the risk of disease spread.

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In most cases, the rash and other symptoms of scarlet fever will be gone in about 10 days to 2 weeks with antibiotic treatment. However, scarlet fever can cause serious complications. These can include:

rheumatic fever

kidney disease (glomerulonephritis)

ear infections

throat abscesses



Ear infections, throat abscesses, and pneumonia can best be avoided if scarlet fever is treated promptly with the proper antibiotics. Other complications are known to be the result of the body’s immune response to the infection rather than the bacteria themselves.


While there is no vaccine to prevent scarlet fever, there are things people can do to protect themselves and others. Washing your hands often is the best way to keep from getting or spreading germs like group A strep. The best way to keep from getting or spreading group A strep is to wash your hands often.