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Scarlet fever

Dr Roger Henderson
Reviewed by Roger HendersonReviewed on 29.04.2024 | 4 minutes read

Scarlet fever is the name given to a distinctive collection of symptoms caused by the Group A Streptococcus bacteria, often called Strep A. This bacteria is active every year and usually causes fever and a sore throat in children. Strep throat usually requires antibiotics.

It mainly affects children aged 4 to 14 and appears in late winter/early spring. In late 2022, an outbreak caused great alarm as cases quickly rose, and with this, a small proportion of children became very unwell or died.

The welcome news is that this is not a new strain and should respond to the usual antibiotics. Public health authorities have sought to reassure that most cases are mild and easily treated but warn to be alert to signs that any child may be becoming unwell. Let's talk you through what signs and symptoms to look for and when there is reason to worry.

Doctor’s advice

What are the symptoms of scarlet fever?

Rarely, strep A can cause a flu-like illness – sore throat, high fever, swollen lymph nodes in the neck and possibly headaches, muscle aches, nausea and vomiting.

This becomes known as scarlet fever if a distinctive rash appears 12 to 48 hours later. Small raised red bumps appear on the chest and abdomen and rapidly spread to other areas.

The key characteristic is that this feels rough to the touch, like sandpaper. This is the crucial finding in skin of colour, where it may be harder to see any redness. Some children develop what is called a strawberry tongue, where the tongue is bright red with white dots like strawberry pips. The cheeks do not have a distinctive rash but can look very red.

How does the doctor on your appointment diagnose scarlet fever?

Scarlet fever is frequently diagnosed by examining the child. The doctor will often look for signs of fever, a strawberry tongue appearance, and a sandpaper-like rash on the body.

They may also carry out additional tests, including a throat swab to test for bacteria and look for other signs by a possible blood test if necessary.

How is Scarlet fever treated?

Scarlet fever is a bacterial infection that is often easily treated with antibiotics. On positive diagnosis, the doctor will often prescribe antibiotics, usually penicillin based, but may prescribe others types if necessary.

Antibiotics will often reduce the risk of pneumonia and the spread of infection. The course of antibiotics must be completed.

Things you can do at home to help with scarlet fever

Scarlet fever can be spread 6 days before symptoms show and 24 hours after the first antibiotic treatment.

  • To reduce spread, children should be taken home from school and stay at home for at least 24 hours after taking the first dosage of antibiotics for scarlet fever.
  • Reduce fever and pain by using paracetamol and ibuprofen. Such as Calpol or Nurofen for children.
  • Eat soft food while the throat is sore. It is also essential for the child to stay hydrated by drinking plenty of fluids.
  • Antihistamines such as Chlorphenamine (Piriton) or calamine lotion can also be used to ease itching.

Scarlet fever can last for up to a week. If the child has not improved in that time, they should see the doctor for a follow-up.

Is scarlet fever dangerous?

It rarely causes serious illness, but it's important children with scarlet fever are assessed urgently and given antibiotics to prevent complications such as pneumonia and sepsis and prevent spread to others.

Is scarlet fever contagious?

Yes, occasionally outbreaks occur and it has hit the headlines in winter 2022 as it has come early in the season and has caused some fatalities. It rarely causes serious illness, but if more children catch it, there are more cases of severe illness among them. This includes sepsis, where it spreads to the bloodstream, and pneumonia, which is a chest infection.

Understandably this causes a great deal of anxiety among parents, as sore throats and fevers are extremely common during the nursery and school years.

What to do if you suspect a child has scarlet fever?

You should seek medical advice from your doctor or healthcare professional in your area if you suspect your child has scarlet fever and they have mild symptoms. A phone consultation with your doctor may be recommended since it is contagious as the first step in some cases.

If your child has scarlet fever, keep them at home until at least 24 hours after starting antibiotic treatment to avoid spreading the infection to others.

If you, or your child's scarlet fever doesn't improve in a week (after already seeing a doctor), consult a doctor for a follow-up. If you or your child is sick weeks after recovering from scarlet fever – as this could be an indication of rheumatic fever

Call NHS 111, contact 999 or go straight to the emergency department if:

  • your child is having difficulty breathing, you may notice grunting noises or their tummy sucking under their ribs
  • there are pauses when your child breathes
  • your child's skin, tongue or lips are blue

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Dr Roger Henderson
Reviewed by Roger Henderson
Reviewed on 29.04.2024
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