Symptoms and Signs of Scarlet Fever

Medical Author:
Medically Reviewed on 2/16/2022

Doctor's Notes on Scarlet Fever

Scarlet fever (also termed scarlatina) is a childhood disease usually occurring in children 2 – 10 years of age (although it can occur in older children and adults) that is characterized by feversore throat, and a characteristic rash. The symptoms and signs of scarlet fever begin about four days after exposure to streptococcal infection and may include 

The typical rash, consisting of multiple scarlet-red punctate lesions that are small and rough like sandpaper, begins on the chest, neck, and armpits and then spreads to other areas of the body.

  • The rash is darker appearing in skin creases; ruptured capillaries in these areas may appear to be lined (termed Pastia lines).
  • The face may appear flushed and there may be paleness around the mouth.
  • The white coating on the tongue starts in the first one or two days of illness and then it sloughs off revealing a red-colored tongue with prominent papillae (termed strawberry tongue).
  • As the patient resolves the infection, the rash fades and the skin begins to peel off; this peeling may last for several weeks.

Scarlet fever is caused by infection with group A beta-hemolytic streptococci bacteria that secretes a toxin responsible for the scarlet-colored rash.

What are the treatments for scarlet fever?

The treatments for scarlet fever usually are antibiotics:

  • Oral penicillin
  • Oral amoxicillin
  • Oral erythromycin (especially for penicillin-allergic individuals
  • IM injection of penicillin G (one injection)

Although mild scarlet fever may resolve without antibiotics in about one week, antibiotics speed recovery and reduce the risk of complications.

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.