Scarlet Fever

What is scarlet fever?

Scarlet fever is a strep throat infection with a rash. Your child will have a sore throat and fever before the rash (usually 18 to 24 hours before). Once your child gets the rash, it will spread all over the body within 24 hours.

Your child will have:

  • Reddened, sunburned-looking skin (especially on the chest and abdomen) that feels rough, somewhat like sandpaper. On close inspection, the redness is speckled (tiny pink dots).
  • Increased redness in skin folds (especially the groin, armpits, and elbow creases)
  • Flushed face with paleness around the mouth
  • A sore throat and fever
  • Swollen glands in the neck (in some cases)

What is the cause?

Scarlet fever is caused by the strep bacteria. The rash is caused by a toxin that is produced by some strep bacteria. The complication rate is no different than the complication rate for a strep throat infection alone.

How long does it last?

The red rash usually clears in 4 or 5 days. Sometimes the skin peels in 1 to 2 weeks where the rash was most prominent (for example, the groin). The skin on the fingertips also commonly peels. Your child will stop having a sore throat and fever after taking an antibiotic for 1 or 2 days.

How can I take care of my child?

  • Antibiotics

    Your child needs the antibiotic prescribed by your healthcare provider.

    Try not to forget any of the doses. Give the medicine until all the pills are gone or the bottle is empty. Even though your child will feel better in a few days, give the antibiotic for 10 days to keep the strep throat from flaring up again.

    If the medicine is a liquid, store it in the refrigerator. Use a measuring spoon to be sure that you give the right amount.

    A long-acting penicillin (Bicillin) injection can be given if your child will not take oral medicines or if it will be impossible for you to give the medicine regularly. (Note: If given correctly, the oral antibiotic works just as rapidly and effectively as a shot.)

  • Relief of sore throat or fever

    Acetaminophen or ibuprofen is very helpful for throat pain. Children over 1 year old can sip warm chicken broth or apple juice. Children over 6 years old can suck on hard candy or lollipops. Also give acetaminophen (Tylenol) or ibuprofen (Advil) for fevers over 102°F (39°F). A humidifier helps to keep the air in your child’s room moist. This will keep the throat from getting dry and more painful.

  • The rash

    The rash itself needs no treatment. It generally clears in 4 to 5 days. If it peels, apply a moisturizing cream.

  • Contagiousness

    Your child is no longer contagious after he or she has been on an antibiotic for 24 hours. Therefore, your child can return to school after 1 day if he or she is feeling better. The rash itself is not contagious.

  • Strep tests for the family

    Scarlet fever and strep throat can spread to others in the family. Any child or adult who lives in your home and has a fever, sore throat, runny nose, headache, vomiting, or sores; or who doesn’t want to eat; or who develops these symptoms in the next 5 days should have a rapid strep test or throat culture. Usually, your healthcare provider needs to culture only those who are sick. (EXCEPTION: In families where relatives have had rheumatic fever or frequent strep infections, everyone should come in for a test.) Your healthcare provider will call you if any of the tests are positive for strep.

  • Recurrent strep throat and repeat Strep tests

    Usually repeat throat cultures are not necessary if your child takes all of the antibiotic. However, if your child continues to have a sore throat or mild fever after treatment is completed, return for a second test. If it is positive, your child will be given a different antibiotic.

When should I call my child’s healthcare provider?


  • Your child starts acting very sick.

Call during office hours if:

  • The fever lasts over 48 hours after your child starts taking the antibiotic.
  • Your child continues to have a sore throat after antibiotic treatment is completed.
  • You have other concerns or questions.
Written by Barton D. Schmitt, MD, author of “My Child Is Sick,” American Academy of Pediatrics Books.
Pediatric Advisor 2015.1 published by RelayHealth.
Last modified: 2009-11-23
Last reviewed: 2014-06-10
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright ©1986-2015 Barton D. Schmitt, MD. All rights reserved.

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