Scarlet fever: Causes, symptoms, treatment, and complications

Scarlet fever, or scarlatina, is an illness involving a distinctive pink-red rash.

It mainly affects children. Left untreated, it can sometimes lead to severe complications.

In the past, it was a serious childhood illness, but modern antibiotics have made it much rarer and less threatening.

However, occasional and significant outbreaks still occur.

Children aged 5 to 15 years have a higher risk of developing scarlet fever than other age groups. Around 80 percent of cases occur in children under 10 years.

Fast facts on scarlet fever

Here are some key points about scarlet fever. More detail is in the main article.

Scarlet fever is less common now than in the past, but outbreaks still occur.

The bacteria that causes strep throat is also responsible for scarlet fever.

It can be successfully treated with antibiotics.

The primary symptoms are a rash, a sore throat, and a fever.


Scarlet fever
Scarlet fever can cause a distinctive rash among other symptoms.

Scarlet fever is caused by a toxin released by the bacteria Streptococcus pyogenes (S. pyrogenes), the same organism that causes strep throat.

A small percentage of patients with strep infections, such as strep throat or impetigo, develop scarlet fever.

Another term, scarlatina is often used interchangeably with scarlet fever, but scarlatina more commonly
refers to a less acute form.

Early treatment with antibiotics can prevent complications.


Signs and symptoms generally appear about 1 to 4 days after initial infection. The first symptoms of scarlet fever are usually:

a red, sore throat, sometimes with white or yellowish patches

a fever of 101 Fahrenheit (38.3 Celsius) or higher, frequently with chills.

A rash appears 12 to 48 hours after these first symptoms.

Red blotches appear on the skin. These turn into a fine pink-red rash that looks like sunburn. The skin feels rough when touched, like sandpaper.

The rash spreads to the ears, neck, elbows, inner thighs and groin, chest, and other parts of the body.

It does not usually appear on the face, but the patient’s cheeks will become flushed, and the area around the mouth becomes pale.

If a glass is pressed on the skin, the rash will turn white.

After about 6 days, the rash usually fades. In milder cases, the rash may be the only symptom.

Other possible symptoms include:

difficulty swallowing

feeling unwell



nausea, vomiting, loss of appetite, and abdominal pain

broken blood vessels in the folds of the body, for example, the armpits, groin, elbows, knees, and neck, known as Pastia’s lines

swollen neck glands, or lymph nodes, that are tender to the touch

a white coating forms on the tongue that peels away, leaving a red and swollen “strawberry” tongue

If severe muscle aches, vomiting, or diarrhea occur, the doctor will need to rule out other possible causes, such as toxic shock syndrome (TSS).

The skin of the hands and feet will peel for up to 6 weeks after the rash has gone.

Scarlet fever strep
Scarlet fever can develop from strep throat.

Scarlet fever is passed on through fluids from the mouth and nose. When a person with scarlet fever coughs or sneezes, the bacteria become airborne in droplets of water.

Another person can catch it by inhaling these droplets or by touching something the droplets land on, such as a door handle, and then touching the nose and mouth.

Touching the skin of a person with a streptococcal skin infection can also spread infection. Sharing towels, baths, clothes, or bed linen with an infected person increases the risk.

A person with scarlet fever who is not treated may be contagious for several weeks, even after symptoms have gone.

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