What Is Scarlet Fever?
Scarlet fever is a bacterial infection that causes a bright red rash. It looks and feels like sandpaper, and it's sometimes called "sandpaper rash."
The infection, also called scarlatina, spreads easily from person to person. It gets its name from the red, bumpy rash that typically covers the body.
Scarlet fever vs. strep throat
The same bacteria causes both scarlet fever and strep throat. The culprit is group A streptococcus, also called group A strep. When the bacteria infects your throat, you have strep throat. You get scarlet fever when a strep A infection in your throat or elsewhere in your body releases toxins into your blood that cause the rash. The toxins also can affect your tongue.
Scarlet fever in adults
This condition is most common among children between the ages of 5 and 15. But anyone exposed to group A strep bacteria can get it.
Scarlet Fever Symptoms
On lighter skin tones, the rash starts out looking like a sunburn. On darker skin tones, it may be harder to spot the color change. But your skin will feel rough like sandpaper, and you'll be able to see the raised rash bumps.
If you press on your skin, the rash may turn pale. The rash may itch.
Other signs that you or your child may have scarlet fever include:
Fever, with or without chills
Sore, red throat that may have white blotches
Swollen glands in the neck
Headache or body aches
Nausea, vomiting, and abdominal pain
Red, swollen tongue that may be bumpy or have a whitish coating (strawberry tongue)
Flushed face with a pale ring around the mouth
Deep red coloring in the creases of the arms, legs, neck, and groin
Trouble swallowing
Small, red bumps on the roof of your mouth (petechiae)
Loss of appetite
After the rash goes away, your skin may peel for several weeks.
What Causes Scarlet Fever?
If you or your child has strep throat, there's a chance it will progress to scarlet fever.
Scarlet fever also can be linked to burns or wounds that become infected -- your own or those of another person.
Is scarlet fever contagious?
Yes, scarlet fever is contagious. The infection is often passed between classmates at school or family members who are in close contact with each other. It's most often spread by contact with the droplets emitted when an infected person coughs or sneezes. It can even be spread if you touch something — like a plate or glass — on which these droplets have landed.
Usually, you'll get symptoms 2 to 5 days after infection. But your symptoms might start as soon as 1 day after infection, or it could take a week for them to show up.
Scarlet Fever Diagnosis
Call your doctor if you or your child has a sore throat, especially if a rash or a fever also is present. Your doctor will run the following tests to check for scarlet fever:
Physical exam. A doctor will take a look at the rash and throat, and see whether lymph nodes are swollen. They'll also look for other symptoms, including:
- Chills
- Fever
- Body ache
- Nausea
- Vomiting
- Poor appetite
Throat swab. To confirm whether scarlet fever or strep throat is causing the symptoms, they’ll swab the throat and tonsils to test for the group A strep bacteria.
Rapid strep test. A rapid test will give results before you leave the office. If that’s negative, the doctor may order a culture, which is a more in-depth test to see if the bacteria is actually present.
It's important to test for strep because other illnesses can cause the same symptoms. They may have different treatments.
Scarlet Fever Treatment
Typically, the treatment for scarlet fever is the same as for strep throat. Antibiotics will clear up scarlet fever by killing the strep bacteria that cause it. It may take a couple of weeks to get back to normal. Be sure to let day care providers and classmates know that they may have been exposed. In the meantime, these are some things you can do to make yourself or your child more comfortable:
- Over-the-counter medicines such as acetaminophen and ibuprofen can help with pain and fever. Never give aspirin to children or teens.
- If your child is 4 or older, soothing drops can help with throat pain.
- Have soft foods, cold drinks, or ice pops while your throat is sore.
- Drink plenty of liquids. They’ll help keep your throat or your child's throat moist and stop dehydration.
- Gargle with salt water to help with mouth and throat pain.
- Add moisture to the air in your home. Use a cool mist humidifier.
- If the rash itches, try an over-the-counter anti-itch cream, and keep your child’s nails trimmed so they don’t hurt themselves scratching.
Scarlet Fever Complications
You should see a doctor right away if you or your child has any of these symptoms:
- New shortness of breath when you're resting
- Trouble breathing (in a child, watch for grunting, flaring nostrils, or chest muscles pulling inward)
- Rapid breathing
- Raspy breathing that coughing doesn't clear
- Chest pain
- Inability to swallow or open your mouth fully
- Drooling
- Muffled voice
- Confusion, inability to stay awake
- Dizziness
- Dehydration
- Vomiting or diarrhea that doesn't clear up
If your child is less than 2 months old, these are additional symptoms that signal an emergency:
- Baby can't be comforted
- Their breathing stops and starts
- A temperature below 96.0 F or above 100.4 F
Complications of scarlet fever are uncommon. They happen when the group A strep bacteria moves into other parts of your body. Among them are:
- Abscesses, or pockets of pus, in your brain or on your tonsils
- Sinus infections
- Pneumonia
- Ear infection
- An infection of the large bone behind your ear (mastoiditis)
- Kidney damage
- Skin infections
- Arthritis
- Osteomyelitis, an infection in a bone
- Septicemia, which happens when the infection spreads to your bloodstream
- Meningitis, inflammation of the tissue around your brain and spinal cord
- Immune system problems, including pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS)
Scarlet fever vs. rheumatic fever
Rheumatic fever is a rare complication of scarlet fever. If scarlet fever or step throat isn't treated, your immune system can overreact. That causes inflammation in your tissues, including joints and organs. It can affect your heart.
Rheumatic fever happens more often in areas that lack access to antibiotics and prompt medical care.
Takeaways
Scarlet fever is caused by bacteria — group A streptococcus, also called group A strep. The same type of bacteria causes strep throat. One of the obvious symptoms is a rough rash that usually starts on the neck and chest and then spreads. Your tongue also might develop white spots or be red and swollen. Other symptoms of infection include fever, chills, sore throat, and body aches. A throat swab or rapid strep test in the doctor's office can confirm the diagnosis. Antibiotics will clear up the infection. Over-the-counter pain relievers may make you more comfortable. Complications of scarlet fever are rare.
Scarlet Fever FAQs
Is scarlet fever dangerous?
If it's not treated with antibiotics, the bacteria that causes scarlet fever can infect your bones, tissue around your spinal cord and brain, and your bloodstream.
Why was scarlet fever so deadly?
Scarlet fever is contagious, so outbreaks in the past used to affect many people. As experts learned more about how the disease spread, they began isolating people who had it. That helped prevent epidemics. Once antibiotics became available in the 1940s, doctors finally had an effective way to combat the infection.
How do you get scarlet fever?
The bacteria that causes the disease can spread through droplets that go into the air when a person coughs or sneezes. You also can get it from touching a surface where droplets have landed.
What is the drug of choice for scarlet fever?
The antibiotics doctors prescribe most for scarlet fever are penicillin and amoxicillin. If you have a penicillin allergy, among the antibiotics you might take instead are:
- Azithromycin
- Cefadroxil
- Cephalexin
- Clarithromycin
- Clindamycin
Is scarlet fever a lifelong illness?
No. Antibiotics will wipe out the infection, and then the rash and other symptoms will begin to clear up. However, having scarlet fever once doesn't give you any kind of immunity. You can get it again.