What Is Scarlet Fever (Scarlatina)? All About Symptoms, Causes, and Medication Treatments

You may recognize the term “scarlet fever” from books and movies. There’s no shortage of heroes coming down with scarlet fever in older stories, from “Little Women” to “The Velveteen Rabbit” and “Frankenstein.”

Outbreaks of scarlet fever were extremely common when these stories were written. And, after decades of quiet, studies show that scarlet fever is making a comeback. Let’s take a look at what you can do to keep yourself and your children protected from scarlet fever.

What causes scarlet fever (scarlatina)?

Scarlet fever, also called scarlatina, is an illness caused by the bacteria Streptococcus pyogenes.

Streptococcus releases a toxin into the bloodstream when it causes an infection. When the immune system fights off this toxin, it creates an inflammatory response. This inflammatory response is what creates the symptoms of scarlet fever.

People who develop scarlet fever always have a Streptococcus infection, usually strep throat. But you don’t need to have strep throat to develop scarlet fever. Any Streptococcus infection can lead to scarlet fever, including impetigo and cellulitis.

What are the symptoms of scarlet fever?

The symptoms of scarlet fever include:

• Scarlatiniform rash: Scarlet fever causes a very distinctive rash. It appears as small, raised spots that start in the groin or armpit and spread to other parts of the body. The spots can be red, violet, or brown. The rash feels rough to the touch and is often referred to as a “sandpaper rash.” It usually starts 2 or 3 days after someone gets exposed to Streptococcus. As the infection heals, the rash goes away and patches of skin peels off, usually after about 1 week.

• Strawberry tongue: When someone gets scarlet fever, their tongue might become swollen and bright red. This is sometimes called “strawberry tongue.” Their cheeks might also look flushed.

• Pastia’s lines: Some people develop red lines in their arms and groin.

• Fever: As expected from the name, people with scarlet fever usually have a fever. They also usually have symptoms related to their underlying Streptococcus infection. This might include sore throat or swollen neck lymph nodes.

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• Antibiotics for strep throat: Not everyone with scarlet fever has strep throat, but it’s quite common. Antibiotics can treat strep and help you feel better faster.

• Natural remedies for strep throat in kids: In addition to antibiotics, these home remedies for strep throat are safe for kids and can help lessen symptoms.

• Impetigo in children: Impetigo is another Streptococcus skin infection that’s common among kids. Here’s what to do.

What does scarlet fever (scarlatina) rash look like?

Here are some pictures of scarlatina in different skin tones so you can see what it looks like. 

Scarlet fever forms a “sandpaper-like” rash.

A strawberry tongue in scarlet fever.

Pastia’s lines forming the inside of the elbow in scarlet fever.

Skin peeling from the scarlet fever rash.

How do you diagnose scarlet fever?

A healthcare professional may be able to diagnose scarlet fever with a physical exam. They’ll also ask you questions about when and on what part of the body the rash started. This is to make sure your experience matches the pattern of scarlet fever.

A healthcare professional will also ask to do a rapid strep test or throat culture. Strep throat is the most common infection associated with scarlet fever, so a positive strep test can help confirm the diagnosis.

Who is at risk of developing scarlet fever?

Children ages 5 through 15 are most likely to develop scarlet fever. That’s because Streptococcus can spread easily from person to person, especially in places like schools.

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Adults can get scarlet fever too. Adults are more likely to get scarlet fever if they:

• Have children ages 5 to 15

• Work with children or have frequent contact with children

• Work in crowded places, like daycare centers and schools

Scarlet fever rarely happens in children younger than 3 years old.

How do you treat scarlet fever?

To treat scarlet fever, you’ll need to get rid of the Streptococcus infection. There are very effective antibiotic treatments that can cure Streptococcus infections, including:

• Penicillin

• Amoxicillin

• Cephalexin

• Cefdinir

• Clindamycin

• Azithromycin

You’ll need to take the medication once or twice a day for 5 to 10 days.

Beyond antibiotics, there are some home remedies that can help you manage the symptoms. The scarlatina rash can be itchy, especially as it starts to heal and peel. Emollients and oatmeal baths can help relieve the itchy feeling.

Your primary care provider may also recommend acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to help with fever and sore throat.

Is scarlet fever serious?

Before antibiotics, scarlet fever was a very serious condition. People became very sick and many children died. Once antibiotics were discovered, outbreaks of scarlet fever became less frequent. Recently, outbreaks have increased, which might be because Streptococcus is changing and becoming more infectious.

But antibiotics still work against Streptococcus. So, with treatment, scarlet fever is no longer a deadly illness. 

Scarlet fever complications

Without treatment, people can still become very sick with scarlet fever and develop complications, like:

• Ear or sinus infections

• Throat abscess

• Blood infections

• Meningitis

• Arthritis

• Kidney disease

• Pneumonia

Scarlet fever can also increase the risk of developing rheumatic fever. Rheumatic fever is the most serious complication of scarlet fever. It’s a medical condition that affects the heart, brain, and joints. People with rheumatic fever can develop permanent heart damage.

If you think you or a family member might have scarlet fever, get medical attention right away. Starting antibiotics early can prevent these serious complications.

How can you prevent scarlet fever?

There’s no vaccine for scarlet fever, but there are still things you can do to protect yourself and others. If you or your child has scarlet fever:

• Stay home from work or school for at least 24 hours after starting antibiotic treatment. 

• Cover your mouth with your elbow or tissue when you cough or sneeze. 

• Wash your hands frequently with soap and water. 

• Do not share items, like cups or towels.

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Written by:

Meredith Grace Merkley, DO, FAAP

Dr. Merkley is a licensed, board-certified pediatrician who has over a decade of experience working in community health. She is currently a National Health Services Corp scholar, and is serving as the medical director of a school-based health clinic at a federally funded health center.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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Images used with permission from VisualDx (www.visualdx.com).