Scarlet fever: Symptoms, diagnosis and treatment

What is scarlet fever?

Scarlet fever is one of those childhood diseases that has been tamed by antibiotics - if recognised and treated. The NHS says it is rare in the UK these days and cases are usually mild.

The disease occurs mostly in children between the ages of two and 10. It's caused by infection with group A streptococcal bacteria - the same bacteria that causes strep throat. Symptoms typically appear three days after exposure to another person with the illness, although this incubation period can be anywhere from one to seven days.

Symptoms of scarlet fever typically include a very high temperature over 38 C and a red, sore throat. Other symptoms may include nausea, vomiting, headache and abdominal pain. A distinctive scarlet rash appears - first on the neck and chest and then all over the body. The rash feels like sandpaper. In areas of skin folds - the armpits and the creases at the elbows and the groin - the rash has a bright red colour. The tongue also becomes swollen and turns bright red. After two to seven days the rash usually disappears, but the tongue may remain swollen for several more days.

As the rash fades, there may be skin peeling around the tips of the fingers and toes and in the groin area.

IMPORTANT! Seek Treatment

Scarlet fever cannot be left to run its course. It can lead to ear infections, pneumonia and serious complications such as kidney problems and rheumatic fever (affecting the joints, heart and other organs).

What causes it?

Scarlet fever is a contagious infection that is caused by streptococcal bacteria. It is spread by contact with nasal or mouth fluids from an infected person.

What are the symptoms of scarlet fever?

Scarlet fever most often occurs in children. Its symptoms may include:

• Bright red or scarlet spotty rash, usually beginning on the neck or chest (often excludes face, palms and soles)
• High temperature
• Chills
• Headache
• Sore throat (although half of patients will not have this symptom)
• Painful swallowing
• Tongue with white coating and red bumps - referred to as strawberry tongue
• Swollen glands in neck
• Vomiting

Seek medical advice if:

Your child develops symptoms of scarlet fever, especially if the child has recently had strep throat. Left untreated, scarlet fever may have serious complications affecting the heart, kidneys and other organs.

How do I know if my child has scarlet fever?

Your GP will examine your child, looking for the characteristic rash, characteristic changes on the tongue called "strawberry tongue", and at the throat. The doctor will swab the throat and send the swab to the lab to examine it for the presence of streptococcal bacteria. A rapid test is usually available.

What are the treatments?

Unless treated with antibiotics, scarlet fever can have serious complications. Seek medical advice immediately if you think your child has the disease. Along with taking antibiotics, your child should get plenty of bed rest and drink lots of fluids. Paracetamol and calamine lotion may be advised.

Never give aspirin to anyone under the age of 16 years who has an infection. It can cause Reye's syndrome, a rare but possibly deadly disease of the liver.

Your GP will prescribe an antibiotic, such as penicillin. If your child is allergic to penicillin, he or she will be given an alternative, such as erythromycin. The medicine must be taken for its entire course, even if the symptoms disappear sooner. 

Children should stay away from school or other children for at least 24 hours after starting antibiotic treatment. Other family members should also be examined and treated if necessary. Before the advent of antibiotics, households were quarantined because of scarlet fever, but this is no longer necessary.