What is scarlet fever (scarlatina)? A contagious rash caused by strep bacteria that is easily treatable.

You’ve probably got some strategies for when you or your kiddo aren’t feeling well. These might include hot tea with honey, ibuprofen and a cool compress, or piling up the bed with pillows and blankets for some extra cozy rest. Regardless, it’s important to watch your (or your child’s) symptoms. Because some symptoms – like a fever that’s paired with a rash – are signals that it’s time for a professional diagnosis.

Scarlet fever, or scarlatina, is one of a number of conditions that have fever and rash among their main symptoms. Although it’s considered mild, treatment is still important for preventing possible side effects or complications, and for reducing its duration, symptoms and contagiousness. Here, we explain what causes it, other key symptoms, and what a diagnosis and treatment look like.

What is scarlet fever?

Scarlet fever is an infection caused by group A streptococcus (strep) bacteria – the main type of bacteria responsible for strep throat. Scarlet fever is mainly characterized by a red rash with a rough, sandpapery texture, which is the body’s inflammation response to toxins that strep bacteria produce.

People’s bodies respond to those toxins differently, so some people can get strep throat without developing scarlet fever, but cases of scarlet fever usually develop alongside strep throat. Less commonly, scarlet fever can also develop alongside skin infections caused by group A strep, such as impetigo.

Like strep throat, anyone can get scarlet fever, but it’s most common in kids 5-15 years old, and spreads easily in crowded environments like schools.

How scarlet fever spreads

During an infection, group A strep bacteria live in the nose and throat. Because of this, they can be spread in the droplets from coughs or sneezes, or through shared objects that have been contaminated by those droplets. It’s also possible to catch scarlet fever by touching impetigo sores, and from group A strep entering the body through broken skin.

Scarlet fever symptoms that overlap with strep throat

When scarlet fever is related to a case of strep throat, strep throat symptoms typically appear before the rash. These symptoms usually include a fever and sore throat, as well as:

• Chills
• Painful swallowing
• Head or body aches
• Stomach pain, nausea or vomiting

What a scarlet fever rash and other symptoms look like

A scarlet fever rash usually starts as small red patches on the torso, underarms and groin. From there, it spreads across most of the body and takes on a rough, sandpapery texture. In skin folds such as at the elbows and armpits, the rash may be particularly red. The rash generally doesn’t spread to the face, but the cheeks may become flushed, and the area around the mouth may be pale. A key difference between scarlet fever and other rash-causing conditions like impetigo, chickenpox and hand-foot-and-mouth disease is that scarlet fever doesn’t involve sores or blisters.

Other physical symptoms of scarlet fever can include:

• Red, swollen tonsils and throat, which may develop whitish or yellowish spots or streaks
• Swollen lymph nodes
• A whitish or yellowish coating on the tongue that fades after a few days, leaving the tongue red and bumpy (which is sometimes called “strawberry tongue”)

How long scarlet fever lasts

In scarlet fever cases involving strep throat, strep throat symptoms will appear 2-5 days after exposure. The rash typically appears a day or two later but can appear earlier or up to a week later. The rash tends to last for about a week, and after it fades, affected skin may peel for several weeks.

How long scarlet fever stays contagious

Without treatment, scarlet fever is contagious for 1-2 weeks. However, doctors generally recommend treating scarlet fever in kids, as it can progress into a more serious condition called rheumatic fever if left untreated. Once the fever is gone and at least 24 hours have passed since starting treatment, scarlet fever is no longer considered contagious.

How scarlet fever is diagnosed

Doctors diagnose scarlet fever with an exam and by testing to confirm that group A strep is present. This generally involves a throat swab.

Scarlet fever is treated using antibiotics

Because scarlet fever is caused by bacteria, it can be treated very effectively with antibiotics. Antibiotics reduce scarlet fever duration, symptoms and contagiousness, in addition to helping prevent complications. Once you or your child have started a course of antibiotics, symptoms should start to improve within 24 hours. However, it’s important to keep taking your antibiotics until you complete the full course.

Home remedies for scarlet fever symptoms

While antibiotics are the main treatment for scarlet fever itself, the symptoms can be managed in a few ways:

• Fever and pain can be reduced using acetaminophen or ibuprofen. Don’t give children or teenagers aspirin, as it’s been linked to a rare condition called Reye’s Syndrome.
• Swelling and discomfort in the mouth and throat can be reduced using saltwater rinses, as well as by keeping a humidifier in the room where you or your child are recovering. Soft foods are also recommended to help keep energy up if swallowing is painful.
• The scarlet fever rash may be itchy, so an over-the-counter anti-itch ointment may reduce the risk of bacteria getting into the skin through scratching. Keeping fingernails trimmed short can also help.

If you’re seeing a rash with fever or other scarlet fever symptoms, talk to a doctor

There are many conditions that can cause skin rashes, so if you or your child are experiencing a rash accompanied by strep or other symptoms, a diagnosis is going to be the key to effective treatment. A primary care doctor can provide the exam, tests and treatment recommendations to help make recovery as fast and comfortable as possible.