Scarlet fever (scarlatina)
Scarlet fever is a throat infection caused by group A streptococcus, with a characteristic rash added on top.
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Medicines commonly prescribed for Scarlet fever (scarlatina)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CAPSULE, 500 mgActive substance: phenoxymethylpenicillinManufacturer: Laboratorios Ern S.A.Prescription requiredDosage form: CAPSULE, 500 mgActive substance: amoxicillinManufacturer: Laboratorios Normon S.A.Prescription requiredDosage form: TABLET, 500 mgActive substance: amoxicillinManufacturer: Almus Farmaceutica S.A.U.Prescription required
Scarlet fever is a throat infection caused by group A streptococcus, with a characteristic rash added on top. The rash appears because some strains of the bacterium release a toxin and the skin reacts to it. It is mainly an illness of pre-school and early primary school children, though adults can catch it too, particularly when a child at home is unwell. What sets it apart from an ordinary viral cold is that here there is a treatment that genuinely works: antibiotics. And the reason for taking them is not only to feel better sooner, but to avoid complications several weeks later, once the scarlet fever itself has been forgotten.
How it starts
For the first day or two scarlet fever looks like flu, and there is no rash yet. The usual picture is:
- a temperature that shoots up, often to 38.5–39 degrees, with shivering;
- a very sore throat and pain on swallowing;
- red, enlarged tonsils, sometimes with white or yellowish patches on them;
- glands at the angle of the jaw that swell and hurt when touched;
- headache and general aching; the child is listless and refuses food;
- in children, nausea, vomiting and tummy pain are common — sometimes the tummy hurts enough that appendicitis is suspected before anyone looks at the throat.
One useful detail: streptococcal throat infection usually comes without a runny nose, a cough, hoarseness or red eyes. If all of those are present, a virus is far more likely, and viruses do not need antibiotics.
The rash, the tongue and the peeling
The rash arrives 12 to 48 hours after the illness begins, and it makes scarlet fever recognisable almost beyond doubt.
- It feels like sandpaper. This is the most reliable sign. The rash is made up of countless tiny raised bumps, and running a palm over the chest or back feels like fine glasspaper. On brown and black skin the redness may be hard to make out, but the roughness is just as easy to feel — go by your fingers, not only by your eyes.
- Where it appears. It starts on the chest, tummy and neck, then spreads over the body. It is heaviest in the skin creases — groin, armpits, the inside of the elbows and behind the knees, where it can form bright lines.
- The face. The cheeks are flushed, but the skin around the mouth and nose stays pale, leaving a striking light triangle on a red face. The rash itself does not appear on the face.
- The tongue. For the first few days it is coated white, with red papillae poking through. Then the coating comes away and the tongue is left bright red with prominent papillae — the classic strawberry or raspberry tongue.
- Peeling. A week to ten days later, once the rash has faded, the skin starts to peel: in fine flakes on the trunk and in large sheets on the palms and the soles. It is a late sign, but so characteristic that the diagnosis is sometimes made in retrospect from it. Peeling is not infectious and needs no treatment beyond a moisturising cream.
How it spreads
The streptococcus travels in droplets of saliva and mucus when someone coughs, sneezes or talks, and also on hands and shared items — crockery, towels, toys. Between catching it and the first symptoms there are usually two to five days.
A person is infectious from the very start of the illness. Untreated, they remain a source of infection for two to three weeks, whereas after starting an antibiotic they stop being a risk to others in roughly a day — one of the reasons treatment is worth having.
Having had scarlet fever does not give full protection afterwards: immunity develops to one particular toxin, and streptococcal throat infections can happen again. There is no vaccine against scarlet fever.
A note on pregnancy: there is no evidence that scarlet fever harms the unborn baby, but it makes the mother genuinely unwell, and antibiotics in pregnancy are chosen by a doctor — many suitable ones are permitted, but the choice is theirs rather than the pharmacy's.
Why the antibiotic course must be finished
The diagnosis is usually made from the appearance of the throat, the tongue and the rash, confirmed where needed with a throat swab — a rapid test or a culture. An antibiotic is then prescribed, most often from the penicillin group, or another suitable class if there is an allergy.
Improvement comes quickly: the temperature falls within a day or two and the throat eases. And that is exactly the moment when the course gets abandoned because "it has all gone anyway". It should not be.
The antibiotic in scarlet fever does several jobs at once:
- it shortens the illness and eases the symptoms;
- within a day it makes the person no longer infectious;
- it prevents the pus-forming complications — an abscess beside the tonsil, infection of the ear, the sinuses and the neck glands;
- and above all it sharply reduces the risk of acute rheumatic fever.
What can happen weeks later
Rheumatic fever develops two to four weeks after the streptococcal infection. The immune system, while attacking the bacterium, mistakes the body's own tissues for the enemy and turns on the joints, the heart, the skin and the nervous system. The worst of it is the damage to the heart valves, which can be permanent. This is exactly why the antibiotic is taken as a full course rather than until the sore throat stops hurting: a short spell of treatment removes the symptoms but does not guarantee that the streptococcus has gone from the throat.
The second delayed problem affects the kidneys: post-streptococcal glomerulonephritis. It too arrives one to three weeks afterwards, and shows itself as puffiness of the face and eyelids in the morning, cloudy or brownish urine the colour of dark tea, passing less urine than usual, and raised blood pressure. If someone starts feeling unwell again after scarlet fever, with aching joints, breathlessness, swelling, or a change in the colour of the urine, that is a reason to see a doctor rather than wait for it to settle.
What helps at home
The antibiotic deals with the infection; simple measures deal with feeling wretched. All of them go alongside the treatment.
- Plenty of fluids: cool water, squash, diluted juice. Drinking is hard with a sore throat, but dehydration is the commonest reason a child with scarlet fever ends up in hospital.
- Soft, unirritating food: purées, soups, yoghurt, ice cream. Sour, spicy and very hot foods are best left for later.
- Painkillers and something for the fever: paracetamol or ibuprofen, at the dose for the weight and age given on the packet. They bring the temperature down and soothe the throat.
- Aspirin is not given to children and teenagers: in them it can cause serious damage to the liver and the brain.
- A cool room with moist air and light clothing are tolerated far better than being wrapped up.
- For itching, a cool shower and a moisturising cream help; if the itch is marked, a doctor may suggest an antihistamine.
- Keeping a child's nails short stops them scratching the skin raw.
When urgent help is needed
Scarlet fever usually runs a straightforward course, but there are situations where waiting is not an option.
Contact a doctor the same day if:
- a child is barely drinking, passing little urine and rarely, with a dry mouth; in a baby, no tears when crying and a sunken soft spot on the head;
- vomiting keeps repeating and makes it impossible to get fluids in;
- the fever persists more than two or three days after the antibiotic was started, or comes back after settling;
- there is earache, discharge from the ear, or sharp tenderness behind the ear;
- the rash and fever appear in someone who currently has chickenpox — the combination is dangerous because the streptococcus gets into the deeper skin through the scratched blisters.
Call an ambulance (in Spain, Italy, Portugal, Poland and Ukraine the single European number is 112) if:
- swallowing even saliva has become impossible, it is dribbling out, and the mouth is held half open and cannot be closed;
- the voice has turned nasal or muffled, the mouth will barely open, and the head tilts to one side on swallowing — that is how an abscess beside the tonsil behaves;
- breathing is difficult, there is a noisy sound on breathing in, and the person needs to sit leaning forwards;
- pinprick blood spots or bruises appear on the skin that do not fade when pressed with the side of a clear glass;
- a child cannot be woken, or is unusually floppy, confused or delirious;
- there is a severe headache with vomiting, discomfort in bright light and a stiff neck;
- an area of skin becomes very painful and dusky purple and spreads rapidly, with pain clearly out of proportion to how it looks.
Keeping it from spreading
While someone is infectious they need sensible isolating. The general principle is simple: stay away from nursery, school or work until about a day after the first dose of antibiotic, and for as long as the fever lasts. The wording and the exact periods in institutional rules differ from country to country, so the precise day of return is best confirmed with your own doctor or with the nursery or school itself.
Everything else is ordinary hygiene, which really does work here:
- wash hands with soap more often than usual, especially after blowing your nose or helping a child;
- cough and sneeze into a tissue and bin it straight away; without a tissue, into the crook of the elbow;
- do not share crockery, cutlery, towels, bedding or toothbrushes with the person who is ill;
- give them their own towel and wash their things as usual, in hot water;
- let the nursery, school or workplace know — others may be affected, and early treatment helps them;
- pregnant women and anyone with weakened immunity are better off keeping their distance for the first day of treatment.
Household members without symptoms are not given antibiotics as a precaution. But if one of them develops a sore throat and a temperature, they should be seen by a doctor: they need treating too.
Online consultation
With a sore throat and a rash, the key question is whether this is streptococcus or a virus, and whether an antibiotic is needed at all. A doctor can work out a great deal from the account alone: how it began, whether there is a cough and a runny nose, when the rash came out, whether it feels rough, what the tongue looks like. From those details you will be told whether a throat swab is worth doing and how urgently a face-to-face examination is needed.
An Oladoctor doctor will explain how to work out the right dose of the fever medicine for a child, how to get fluids in when swallowing hurts, why the antibiotic course must not be broken off and what to do about a missed dose, and will go through with you the list of signs that mean calling an ambulance immediately. It is also worth discussing what to watch for during the month after recovery — that is exactly the window in which the heart and kidney complications make themselves known.
This material is for information only and does not replace medical advice.
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