Scarlet fever: symptoms, treatment, how long contagious

In short

• Scarlet fever is caused by group A strep bacteria. It is most common in children ages 5 through 15, but adults can get it too.
• The usual picture: sore throat, fever and swollen neck glands, then a rough, sandpaper-like rash 12 to 48 hours later and a red, bumpy tongue.
• Treatment is an antibiotic from a clinician. Finish the whole course even if symptoms ease.
• Without antibiotics a person can spread it for 2 to 3 weeks. Contagiousness ends 24 hours after the first antibiotic dose.
• Complications are rare but include ear infection, throat abscess and rheumatic fever, so see a clinician if the illness returns or does not improve.

What scarlet fever is

Group A strep bacteria cause strep throat and scarlet fever. Scarlet fever is essentially a strep infection that also produces a rash. Symptoms usually start 2 to 5 days after someone is exposed to the bacteria.

The CDC says it is most common in children ages 5 through 15 and less common under age 3. Spread happens through close contact, and the bacteria often pass between people who live in the same household. Crowded places such as child care centers and schools are common settings.

Symptoms and what the rash looks like

• Flu-like start: a high temperature, a sore throat and swollen neck glands.
• A rash that appears 12 to 48 hours later, starting on the chest and belly and making the skin feel rough, like sandpaper.
• A white coating on the tongue that peels away, leaving a red, swollen tongue with small bumps, often called a strawberry tongue.
• Red cheeks, while the rash usually does not appear on the face itself.
• On brown and Black skin the color change can be harder to see, but the raised bumps can still be felt and seen.
• Peeling skin as the rash fades, which may show up on the hands and feet.

The illness usually lasts around a week. Headache, nausea, vomiting and stomach pain can also occur, especially in children.

How a clinician confirms it

A clinician often suspects scarlet fever from the throat, the tongue and the rash. According to the CDC, providers can do a quick test to see whether a sore throat is strep, and several other types of tests exist. It matters to tell strep from a virus, because antibiotics help only with bacteria.

Call the office before you go. The NHS notes that practices may prefer a phone consultation first, and phoning ahead also lets staff keep a contagious child away from the waiting room.

Treatment

1. Antibiotics.A clinician prescribes them. Antibiotics help people feel better faster, shorten the illness and lower the chance of complications and of spreading it. The drug and the length of the course are the clinician's decision.
2. Finish the course.Keep taking the antibiotic until it is gone, even if your child is feeling better after a day or two.
3. Ease symptoms.Acetaminophen can bring down a high temperature. Offer cool drinks and soft foods. Do not give aspirin to children under 16, according to the NHS.
4. Soothe itching.Calamine lotion or an antihistamine can help with an itchy rash. Ask a pharmacist or clinician which one is suitable for your child.

How long it is contagious and school return

Without antibiotics, a person can spread scarlet fever for 2 to 3 weeks after symptoms begin. With treatment, the NHS says a person can spread it until 24 hours after the first dose. Your child should stay away from school, child care or work for those 24 hours. Your school or child care center may have its own rule, so ask them.

Hand washing with soap and water is the best protection for the household. Use tissues for coughs and sneezes, throw them away quickly, and do not share cutlery, cups, towels, clothes or bedding with the sick person.

Complications

Complications are not common. If the bacteria spread beyond the throat, they can cause an ear infection, sinusitis, a throat abscess or pneumonia. Strep infections can also lead to rheumatic fever, which can affect the heart, joints, brain and skin, and to a kidney disease called post-streptococcal glomerulonephritis.

See a clinician if there is no improvement after a week, or if your child becomes ill again weeks later, because that can be a sign of rheumatic fever.

When to see a doctor, and red flags

See your primary care provider or pediatrician whenever a sore throat comes with fever and a rash, and again if symptoms do not improve after a week of antibiotics.

Red flags: call 911 if the child is drowsy and hard to wake, has fast or labored breathing, cannot swallow or is drooling, or has a rash that does not fade under pressure, along with looking very unwell. Get same-day care for a patch of skin that is red, hot, swollen and very painful.

Preventing spread at home

• Give the sick person their own cup, towel and bedding, and wash them separately.
• Wash hands with soap after caring for the sick person and before eating.
• Cough and sneeze into a tissue or your elbow.
• If a family member develops a sore throat or fever, have them seen by a clinician.
• The CDC advises seeking health care if you suspect group A strep infection.

Questions and answers

Sources

1. NHS — Scarlet fever
2. CDC — About Scarlet Fever
3. CDC — About Strep Throat

Sources checked on 29 October 2026.