Scarlet fever

Scarlet fever

Scarlet fever: Symptoms, definition, home care, treatment, and prevention


Symptoms

  • Fever of 38.3oC (101oF) or higher
  • Severe sore throat that makes swallowing difficult
  • Stomach ache
  • Nausea and occasional vomiting
  • Reddish rash with small bumps
  • Whitish coating on the tongue; when the white fades, the tongue turns bright red

The rash first appears on the neck and in the skin folds (under the arms, at the elbows, and on the thighs) within 24 to 48 hours after the first symptoms. It can spread to the rest of the body in 2 or 3 days. The rash gives the skin a sandpaper-like texture.

See a doctor if your child has a fever along with any of the symptoms described above.

Go to the emergency room if your child has any of the following symptoms:

  • Inability to eat or drink and infrequent urination
  • Trouble opening their mouth
  • Excessive drooling
  • Severe ear or head pain
  • Seizures
  • A temperature over 40°C (104°F)

What is scarlet fever?

Symptôme de la scarlatine

Scarlet fever is an infection caused by a bacteria called streptococcus. This bacteria produces toxins that cause a rash. Scarlet fever is contagious.

Because there are different types of streptococcal bacteria and the toxins they produce, a person can have scarlet fever more than once in their lifetime. The streptococcus that causes scarlet fever can also infect adults, but it usually causes only a throat infection. Scarlet fever with rash is rare in adults.

In rare cases, the rash may occur without a sore throat coming first. If so, the infection is caused by a different type of bacteria, such as staphylococcus.

If left untreated, scarlet fever can lead to rare complications that affect the ears, kidneys, liver, heart, brain, and joints. It can also cause abscesses at the back of the throat. For that reason, it is very important to see a doctor if you suspect your child has scarlet fever.

Age: Scarlet fever mainly affects children aged 3 to 8, although it can appear at any age.
How it spreads: The illness is spread through droplets in the air when an infected person coughs or sneezes, or through contact with objects contaminated by those secretions (drinking glasses, utensils, toys, hands, etc.).
Incubation period: 2 to 5 days.
Duration: The sore throat lasts 2 or 3 days and the skin rash usually lasts about a week. After that, the child’s skin may start to peel.
Infectious period: Scarlet fever is contagious as soon as the incubation period begins. Contagion ends 24 hours after the child begins taking antibiotics. Without treatment, a child may remain contagious for up to 21 days.
Isolation period: The child can return to daycare or school 24 hours after starting antibiotic treatment.
Vaccine: There is no vaccine against scarlet fever.
Risk of recurrence: According to a Spanish study, the risk of scarlet fever recurrence is around 10%.

Treatment

An antibiotic treatment (in liquid or pill form) can help shorten the duration of the illness and prevent complications and the spread of infection.

It’s very important to complete the full course of the prescribed medication, even if symptoms have subsided. Stopping early can lead to a relapse, cause complications, and lead to antibiotic resistance.

Care and practical advice

  • Encourage quiet activities. Your child doesn’t need to stay in bed all day, but they should get plenty of rest.
  • Give them lots of fluids: water, soup, juice, etc. Avoid juices that are too acidic (e.g., orange juice, lemonade), as they can make a sore throat worse. If your child is having trouble drinking, try making popsicles with grape, pear, or apple juice.
  • Give them soft foods (purees, yogurt, ice cream, etc.) in small portions, 5 or 6 times a day. You can also give them soup: Chicken noodle soup is especially good.
  • Have your child gargle a few times a day with a solution of 2.5 ml (½ tsp) of salt dissolved in a glass of warm water.
  • To relieve pain and fever, give them acetaminophen (Tylenol®, Tempra®) or ibuprofen (Advil®, Motrin®) following the recommended dose for their age and weight. Don’t give ibuprofen to babies under 6 months, and never give Aspirin® (acetylsalicylic acid) to a child or teenager.
  • To relieve itching, you can give your child a long-acting antihistamine such as Claritin®.

Prevention

You can’t completely prevent scarlet fever, but you can lower the risk of spreading it by following basic hygiene measures.

  • Wash your hands with soap if you’ve been in contact with someone who is infected or touched objects they’ve handled. Wash your child’s hands often, and teach them to do it themselves as soon as they’re able—especially after coughing, sneezing, or blowing their nose.
  • Teach your child to cough or sneeze into a tissue. Show them how to use the crook of their elbow instead of their hands when they don’t have a tissue.
  • Clean and disinfect toys, faucets, and door handles, ideally with an alcohol-based cleaner.
  • Set aside dishes, glasses, and cutlery that will only be used by your child until 24 hours after they’ve started antibiotic treatment.
Naître et grandir

Scientific review: Dr. Anne-Claude Bernard-Bonnin, pediatrician
Research and copywriting:The Naître et grandir team
Updated: April 2023

Photos: iStock.com/blackjake and GettyImages/parinyabinsuk

Sources and references

Note: The links to other websites are not updated regularly, and some URLs may have changed since publication. If a link is no longer valid, use search engines to find the relevant information.

  • Public Health Agency of Canada. “Scarlet fever fact sheet.” Government of Canada. 2011. canada.ca
  • Basetti, Stefano, et al. “Scarlet fever: a guide for general practitioners.” London Journal of Primary Care, vol. 9, no. 5, 2017, pp. 77–79. ncbi.nlm.nih.gov
  • De Dios Javierre, Barbara, et al. “Recurrent scarlet fever: A common entity.” Anales de Pediatria, vol. 87, no. 4, 2017, pp. 232–233. analesdepediatria.org
  • Doré, Nicole, and Danielle Le Hénaff. From Tiny Tot to Toddler: A practical guide for parents from pregnancy to age two. Quebec City, Institut national de santé publique du Québec. inspq.qc.ca
  • Nemours KidsHealth. “Scarlet fever.” KidsHealth. 2022. kidshealth.org
  • Labbé, Jean. Votre enfant a 3 ans. 2021, fmed.ulaval.ca
  • Mayo Clinic. “Scarlet fever.” Mayo Clinic. 2022. mayoclinic.org
  • Ministère de la Famille. “Les infections en milieu de garde.” Gouvernement du Québec. 2019. mfa.gouv.qc.ca
  • Canadian Paediatric Society. “Common infections and your child.” Caring for Kids. 2018. caringforkids.cps.ca

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