Scarlet fever

Scarlet fever is a bacterial illness that mostly affects children, and it causes a distinctive pink-red rash.

The bacteria behind it are called Streptococcus pyogenes, also known as Group A Streptococcus. They live on the skin and in the throat.

Scarlet fever usually comes after a sore throat or a skin infection, such as impetigo, caused by particular strains of Streptococcus bacteria.

The symptoms of scarlet fever normally appear 2 to 5 days after infection. The incubation period (the time between catching the infection and the first symptoms) can be as short as one day, though, or as long as 7 days.

See a doctor if you or your child:

• have symptoms of scarlet fever
• do not get better in a week (after seeing a doctor)
• have scarlet fever and chickenpox at the same time
• are ill again weeks after scarlet fever got better, because this can be a sign of a complication like rheumatic fever
• are feeling unwell and have been in contact with someone who has scarlet fever

The rash of scarlet fever is pink-red, and it usually appears 12 to 48 hours after the first symptoms, such as a sore throat or headache.

It begins with red blotches. These turn into a fine pink-red rash that feels like sandpaper when you touch it and looks like sunburn. It may also itch.

On darker skin the rash can be harder to see, but you should still be able to feel its rough texture.

The rash usually starts on the chest and stomach, then soon spreads to other parts of the body, like the:

• ears
• neck
• elbows
• inner thighs
• groin

It doesn't usually reach the face. The cheeks do become flushed, though, and the area just around the mouth stays quite pale. If you press a glass on the rash, it will turn white.

The rash usually fades after about a week. The outer layers of skin, usually on the hands and feet, may peel for several weeks afterwards.

In milder cases, sometimes called scarlatina, the rash may be the only symptom.

Scarlet fever can cause other symptoms too, including:

• swollen neck glands
• loss of appetite
• nausea or vomiting
• red lines in the folds of the body, such as the armpit, which may last a couple of days after the rash has gone
• a white coating on the tongue, which peels a few days later and leaves the tongue red and swollen (this is known as strawberry tongue)
• a general feeling of being unwell

If you think you or your child may have scarlet fever, see your doctor for a proper diagnosis and the right treatment. It usually clears up after about a week.

A doctor should be able to diagnose scarlet fever by looking at the distinctive rash and asking about your other symptoms. They may also take a sample of saliva from the back of your throat, so it can be tested in a laboratory to confirm the diagnosis.

There's no evidence to suggest that catching scarlet fever while pregnant will put your baby at risk. But if you're heavily pregnant, tell the doctors and midwives looking after you if you've been in contact with someone who has scarlet fever.

Scarlet fever spreads very easily. You can catch it in these ways:

• by breathing in bacteria in airborne droplets from an infected person's coughs and sneezes
• by touching the skin of a person who has a Streptococcal skin infection, such as impetigo
• by sharing contaminated towels, baths, clothes or bed linen

You can also catch scarlet fever from people who carry the bacteria in their throat or on their skin but have no symptoms at all.

Most cases of scarlet fever happen in children under 10, usually between 2 and 8 years of age. But people of any age can get it.

Scarlet fever spreads easily. If you're in close contact with someone who has a sore throat or a skin infection caused by Streptococcus bacteria, you are likely to catch it. Outbreaks can happen in nurseries and schools, where children are close to one another.

The symptoms of scarlet fever only develop in people who are susceptible to the toxins that Streptococcus bacteria produce. Most children over 10 years of age have already developed immunity to these toxins.

You can have scarlet fever more than once, but this is rare.

Most cases of scarlet fever clear up after about a week without treatment. Even so, your doctor may recommend treatment, because it:

• reduces the length of time you're infectious
• speeds up recovery
• lowers the risk of complications of scarlet fever

With treatment, most people recover in about 4 to 5 days. They can go back to nursery, school or work 24 hours after starting antibiotic treatment.

Without treatment, you'll be infectious for 1 to 2 weeks after symptoms appear.

Doctors usually treat scarlet fever with a 10-day course of antibiotics. Most often these are penicillin or amoxicillin tablets, though young children may be given a liquid instead.

If you or your child are allergic to penicillin, a different antibiotic such as erythromycin can be used.

Symptoms usually start to improve within 24 hours of the first dose, and the rest settle over the next few days. Even so, finish the whole course. That makes sure the infection is fully cleared, and it lowers the chance of antibiotic resistance developing.

Keep your child away from nursery or school for at least 24 hours after they start the antibiotics. Adults with scarlet fever should also stay off work for at least 24 hours after starting treatment.

Most of the symptoms of scarlet fever can be eased with a few simple self care measures.

• drink plenty of cool fluids
• eat soft foods if your throat is painful
• take paracetamol to bring down a high temperature
• use calamine lotion or antihistamines to relieve itching

Most people with scarlet fever don't develop complications, especially when the condition is properly treated.

There is, though, a small risk that the infection spreads to other parts of the body and causes more serious infections, such as:

• an ear infection
• a throat abscess (a painful collection of pus)
• sinusitis (inflammation of the sinuses)
• pneumonia (inflammation of the lungs)

Some complications are very rare and can appear at a later stage. These include:

• bacteraemia (an infection of the bloodstream)
• septic arthritis
• meningitis
• necrotising fasciitis (a severe infection involving death of areas of soft tissue below the skin)
• Streptococcal toxic shock syndrome (rapidly progressive symptoms with low blood pressure and multi-organ failure)

Talk to a doctor straight away if you or your child develop any of these symptoms in the first few weeks after the main infection has cleared up:

• feeling very unwell
• severe pain
• severe headaches
• vomiting
• diarrhoea

If you can't reach a doctor, call a doctor or the 16263 health line.

There's no vaccine for scarlet fever at present.

If your child has scarlet fever, keep them away from nursery or school for at least 24 hours after they start antibiotics. Adults who have the illness should also stay off work for at least 24 hours after starting treatment.

Doctors, schools and nurseries should know that scarlet fever is currently at high levels. If they come across cases, particularly more than one affected child, they should inform the local health protection teams.

• cover your mouth and nose with a tissue when you cough or sneeze
• wash your hands with soap and water after you use or throw away tissues

• don't share contaminated utensils, cups and glasses, clothes, baths, bed linen or towels

Don't include personal information, for example your name, location or any personal health conditions.