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What is scarlet fever?

Young boy with symptoms of scarlet fever
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Scarlet fever is a bacterial infection that mainly affects young children, causing a recognisable rash. It is caused by Streptococcus pyogenes bacteria, also known as Group A Streptococcus, or strep A. Whilst not particularly common, cases of Strep A infections have increased in recent years. In this guide you’ll learn how to spot the symptoms of scarlet fever so that you can treat the illness as soon as possible.

What are the signs and symptoms of scarlet fever?

Scarlet fever begins with flu-like symptoms including a sore throat, swollen neck glands and temperature. 12 to 48 hours later, this is followed by a red-pink rash on the chest and tummy and a white coating on the tongue.

You should speak to your GP if you or your child have the following symptoms:

  • A sore throat
  • A high temperature above 38.3°C/101°F
  • A headache
  • A rough textured rash with small, raised bumps
  • A swollen tongue with little bumps
  • Red, flushed cheeks

Other symptoms can include a loss of appetite, nausea and red lines in the folds of the body.

What does scarlet fever look like?

Scarlet fever is most easily identified by two visible symptoms; a rash and swollen tongue. A rash will appear on the body with raised bumps that make the skin feel like sandpaper.

Scarlet fever rash on hands

It will look pink or red on white skin but may be harder to see on brown or black skin so make sure to feel for a rough texture. This rash usually starts on the chest and stomach, spreading to other areas such as the thighs, elbows, neck and ears. It doesn’t appear on the face but cheeks may become flushed.

Scarlet fever rash on back

‘Strawberry tongue’ is also a visible symptom. Look out for a white coating on the tongue that peels leaving it swollen, red and bumpy.

Strawberry tongue

Scarlet fever can sometimes be mistaken for other skin conditions such as eczema. Find out more about the most common children’s skin rashes so you can spot the difference.

What are the causes of scarlet fever?

Scarlet fever is caused by Group A Streptococcus bacteria which can be found on the skin and in the throat. It is spread through skin to skin contact with someone who has an infection or by breathing in bacteria from their coughs or sneezes. Sharing contaminated bed linen, towels and clothing can also be a cause.

It's possible to test for Group A Streptococcus at home using a self-test kit. This is a convenient option for those who want to confirm a diagnosis before seeking medical treatment.

Shop our strep A at-home test

Is scarlet fever contagious?

Scarlet fever is an airborne disease that can also be spread by indirect and direct contact. This makes it highly contagious. It is spread through contact with a person’s mucus or saliva; either someone who is infected or someone who is carrying the bacteria and doesn’t have symptoms. This can occur via skin to skin contact, by breathing in infected airborne droplets or by touching surfaces such as cups, tables, pens and toys.

Washing your hands for at least 20 seconds can help to stop the spread, as can using antibacterial products such as hand sanitisers. If you have scarlet fever, make sure to cough and sneeze into tissues before discarding them.

Who is at risk of scarlet fever?

Anyone can catch scarlet fever however it is most common in children. 9 in 10 cases of scarlet fever occur in children under 10, most of which are between the ages of 2 and 8 years old.

Cases of scarlet fever are increasing. From September 2022 - September 2023, there were 4,622 notifications of scarlet fever compared to an average of 1,294 during the same period over the last five years.

Scarlet fever in pregnancy risks

There is no evidence that suggests scarlet fever can put your baby at risk during pregnancy. However, it’s advised to tell your doctors and midwives if you’ve been in contact with someone who has scarlet fever or if you feel unwell. Find out more about what to do if you have symptoms of the flu during pregnancy.

How do you treat scarlet fever?

Antibiotics are the most effective treatment for scarlet fever and can help you to get better within 4 to 5 days. They will also reduce how long you are infectious for and lower the risk of it progressing to a serious illness such as pneumonia.

Most people will receive a 10-day course of antibiotics in the form of penicillin or amoxicillin tablets for adults and liquid for children. Alternatives are available for people with allergies. Book an appointment with your GP. You should also see your doctor if you or your child do not get better within a week, become ill again after having scarlet fever or have chickenpox at the same time.

You can also treat symptoms of scarlet fever at home with over the counter treatments and remedies such as:

Some fever and flu medication contains painkillers such as paracetamol so may not be suitable to take with pain relief.

What are the complications of scarlet fever?

It's important to take antibiotics if you or your child has scarlet fever. This is the best way to stop it from becoming a serious illness.

Complications from scarlet fever are rare but can happen if not treated. They can include:

Do you have to isolate with scarlet fever?

If you or your child has scarlet fever, you should keep away from nursery, school or work for at least 24 hours after starting treatment with antibiotics. This will help to stop the spread. Schools and nurseries should then inform local health protection teams to record the number of cases.

You should also cover your mouth and nose with a tissue when coughing or sneezing and wash your hands afterwards. Do not share items such as bed linen, towels, cups and utensils until you have recovered.

How common is scarlet fever?

Scarlet fever is most common in children under 10, with the highest number of cases in those that are 4 years old. It is much less common than it used to be but cases have begun to increase in recent years.

What are the precautions for scarlet fever?

There is no vaccine for scarlet fever however you can help to prevent the spread of the infection by washing your hands regularly and staying away from those who have symptoms. You should also avoid sharing eating utensils or glasses.

In summary, scarlet fever is a common infection that is very contagious, particularly for families with children of school age. It’s most easily identified by a red, rough rash and swollen, bumpy tongue known as ‘strawberry tongue’. Thankfully it can be easily treated with antibiotics and over the counter medication to soothe symptoms such as a high temperature and sore throat including children’s fever and pain relief.

Find out more about how to treat common illnesses including cradle cap and tonsillitis. You can also learn how to spot the difference between cold and flu  and get advice on how to soothe a sore throat.