Scarlet fever is caused by infection with streptococcal bacteria. These are the same bacteria that cause strep throat. It's spread on droplets that travel through the air when a person coughs.
Symptoms include throat pain that can start quickly, pain when swallowing, or a painful site of skin infection, along with a rash. The rash often appears a few days after the sore throat. It looks like tiny raised pink dots with a rough feeling like sandpaper. The tongue may have a whitish coating and be red with small bumps on it (called strawberry tongue). You may also have red, swollen tonsils, sometimes with white patches or streaks of pus and tiny red spots on the roof of the mouth. Headache, body aches, and a fever are also common.
Untreated, the streptococcal bacteria can spread to other parts of the body, causing blood stream infection, pneumonia, and other complications. Untreated, scarlet fever can also lead to rheumatic fever. This is a condition of the heart, nervous system, and other parts of the body.
Antibiotics are used to treat the infection. You may start feeling better after a few days of treatment. The rash often clears up after 4 to 5 days. The skin may peel (like a bad sunburn) in 1 to 2 weeks.
Home care
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Rest at home for at least the first few days.
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Take the antibiotic medicines as directed until they're gone, even if you feel better or your health care provider tells you to stop. This is very important to prevent later problems from strep infection (such as heart or kidney disease).
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Fever increases water loss from the body. Drink plenty of fluids.
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Ask your provider before taking any over-the-counter medicines.
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Stay home from work or school until you have finished at least 2 days of antibiotics, no longer have a fever, and are feeling better.
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Use throat lozenges as needed to help reduce throat pain. Gargling with warm salt water may also help. Dissolve 1/2 teaspoon of salt in 1 glass of warm water.
Follow-up care
Follow up with your health care provider or our staff as directed.
When to call your doctor
Contact your health care provider right away if:
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You have a fever of 100.4°F (38°C) or higher, or as directed by your provider.
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You have throat pain or headache that's getting worse.
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You have neck pain or stiffness.
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You have a dark purple rash.
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You have blood in your urine.
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You have joint pain or swelling.
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Your symptoms get worse or new symptoms appear.
Call 911
Call
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You have throat pain causing severe drooling, inability to swallow, or inability to open your mouth wide.
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You have trouble breathing.
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You are abnormally drowsy or confused.
Online Medical Reviewer: Barry Zingman MD
Online Medical Reviewer: Louise Cunningham RN BSN
Online Medical Reviewer: Marianne Fraser MSN RN
Date Last Reviewed: 01/01/2025
© 2000-2026 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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