Scarlet fever (disease): what it is, symptoms, photos, treatment

Common in children between 5 and 15 years old, scarlet fever is a disease that, if left untreated, can bring serious health complications, such as kidney and heart problems.

The condition is contagious and spreads mainly in closed places with a lot of circulation, such as public transport, schools and work environments.

Find out more about this disease and how to prevent it in the following text!

What is scarlet fever?

Scarlet fever is a disease caused by a bacterium called Streptococcus pyogenes . It usually affects people who have streptococcal pharyngitis , a disease characterized by inflammation of the throat caused by Streptococcus .

In the case of scarlet fever, Streptococcus is responsible for the production of a substance that causes inflammatory responses in the body, causing the classic symptoms of the disease.

Among the most characteristic symptoms, we can mention the appearance of red and rough skin rashes that cover much of the body.

In addition, a type of pallor followed by peeling and redness on the skin around the mouth and tongue, with the appearance of small red dots at the bottom of the roof of the mouth, are also common.

In most cases, these and other symptoms are also accompanied by pharyngitis and a high fever .

Scarlet fever is more common in children between 5 and 15 years of age. This is because children have not yet developed protective antibodies that protect against toxins released by Streptococcus .

Usually, after 10 years of age, about 80% of children have already developed these antibodies and are less likely to develop the disease.

However, you need to be aware that not all Streptococcus produce the toxin responsible for scarlet fever. In addition, not all children are sensitive to this toxin.

Children infected with Streptococcus and who live in the same house can develop the disease in different ways, because each one can react to the toxin in a different way, or not at all.

Although it has already been considered a serious condition, with the evolution of antibiotic treatments , it has become less dangerous.

Still, if left untreated, it can result in more serious conditions, affecting the heart, kidneys and other parts of the body.

This disease can be found in the International Classification of Diseases, the ICD-10 , through the code A38 .

Cause: what is the scarlet fever bacterium?

Scarlet fever is caused by toxins produced by the bacteria Streptococcus pyogenes (or simply group A hemolytic beta streptococcus), which cause inflammation of the skin and throat. Over time, the human body develops immunity to the bacteria, so the disease tends to affect more children than adults.

A natural reservoir for Streptococcus is the skin of the human being, and this bacterium commonly causes infections in the throat, more specifically streptococcal pharyngitis , which causes inflammation and pain in the throat.

Usually, this disease ends up first affecting children who have wounds or burns infected with Streptococcus or because of infections in the upper respiratory tract also caused by the same bacteria, as in the case of streptococcal pharyngitis.

Other bacteria that can also cause scarlet fever are Staphylococcus aureus , Haemophilus influenzae and some species of Clostridium .

These infectious agents are transmitted from person to person through droplets of water expelled when an infected patient coughs or sneezes.

The incubation period (the time between the time of exposure and the onset of symptoms) is usually 2 to 4 days.

Transmission: is it contagious?

Scarlet fever is transmitted through fluids from the mouth and nose . When an infected person coughs or sneezes, the bacteria can spread through the air in droplets of water.

Transmission effectively occurs when another healthy person inhales the air or touches surfaces where the droplets are. For example, when touching a doorknob and then bringing your hand to your mouth or nose.

For this reason, Streptococcus pyogenes spreads more easily in closed environments and where people come in close contact, such as schools, workplaces, at home and on public transport.

Touching the skin of an infected person as well, sharing bath towels, clothes and bedding also increases the risk of transmission.

When a person with scarlet fever is not treated, they can continue to spread the bacteria for several weeks, even after the symptoms have disappeared.

In addition, some individuals do not react to the infection, that is, they do not show any symptoms, but they are carriers of the disease.

Therefore, they can still transmit the bacteria to other people. This makes it difficult to know whether or not you have been exposed.

Although less common, transmission is possible through the consumption of food contaminated with Streptococcus , especially milk that, if it does not pass through the correct pasteurization process, can continue to be contaminated with the bacteria.

Still, there are some people who may have scarlet fever and not pass it on. In these cases, the person has a different type of Streptococcus that is unable to multiply as efficiently, which reduces the numbers of infection.

Despite this, when the first signs of the disease appear, it is necessary to take precautionary measures to prevent the disease from spreading.

Groups of risk

Anyone can have scarlet fever, however, there are some groups that are most at risk. As with streptococcal pharyngitis, scarlet fever is more common in children between 5 and 15 years old, being rare in children under 3 years old.

Among adults who are at greater risk of contracting scarlet fever, we can highlight:

  • Parents of school-age children;
  • Adults who come into contact with children daily, such as teachers, educators, psychologists, etc.

This is because the biggest risk factor for scarlet fever is contact and living with the infected person.

People who live in the same house as a scarlet fever patient, for example, can be infected by sharing the same environment, as the infected patient may have contaminated furniture and household objects with sneezing or coughing.

Infectious diseases usually spread in situations where a large group of people crowd together, so crowded places are a big dish for the disease to spread. From these locations, we can highlight:

  • Schools;
  • Creches;
  • Public transport;
  • Desktop.

Symptoms of scarlet fever

Scarlet fever has characteristic symptoms, which are skin rashes. These rashes are caused by a toxin that induces inflammatory responses in the body.

Some children present, in the first days, pallor around the mouth and tongue. Over time, the appearance of the eruptions is close to that of a strawberry.

Understand more about this and other symptoms:

Skin rashes

Skin rashes can be considered the main symptom of scarlet fever. They are red, rough to the touch, like sandpaper, and itchy. They last on average just over a week.

They are like red spots that usually appear first on the neck, face, armpit and groin, spreading later on the chest, back and rest of the body.

Gradually, they disappear and, with that, flaking around the hands, fingers and also the groin may occur.

Pastia Lines

Skin lesions caused by scarlet fever tend to be clustered in the fold areas, such as the armpits, groins, elbow folds, and reddish lines and features appear in these regions.

In these cases, they are called Lines of Pastia.

Fever and chills

The person infected with scarlet fever may have a high fever (over 37.8 ºC). This symptom usually appears 12 to 48 hours before the rash and may or may not be accompanied by chills.

Swelling on the tongue

One of the characteristic symptoms of scarlet fever is changes in the tongue. The child’s tongue may be swollen and whitish-red with small red dots, making it look like a strawberry.

Throat inflammation

Scarlet fever can cause inflammation in the throat. In the case of children who have tonsils, if they are infected, it is possible to see them reddish and dilated, sometimes covered by a yellowish-white membrane or film.

Other symptoms

In addition to all of these, scarlet fever can still cause other symptoms, such as:

  • Muscle pain;
  • Headache;
  • Abdominal pain;
  • Nausea and vomiting.


Check below some pictures of the most characteristic symptoms of scarlet fever:

How is the diagnosis made?

The doctors who are able to diagnose scarlet fever are the general practitioner , the dermatologist , the infectologist , the otorhinolaryngologist and the pediatrician .

However, blood tests and other tests may be necessary to check for the presence of Streptococcus . Check out:

Complete blood count

complete blood count is a test used to assess a patient’s blood cells. It counts platelets, white blood cells (leukocytes), red blood cells (erythrocytes) and other blood characteristics.

This exam is usually requested by the doctor when he wants to diagnose or control the progress of a disease.

In the case of scarlet fever, a high amount of white blood cells, which are the body’s defense cells, can indicate an infection.

The test also allows you to check for the presence of the Streptococcus itself.


Culture is a type of test that will assess the presence of bacteria in the laboratory.

The medical team takes a sample of saliva or nasal secretions, where the bacteria usually stay to spread more easily, and places this sample on a plate with a liquid nourishing for bacteria.

After a while, the bacteria grow on that plaque until they are visible. It is then analyzed under a microscope to check for the presence of the Streptococcus .

Quick test

The rapid test is developed precisely to check for the presence of Streptococcus.

In it, the professional responsible for the examination collects saliva samples and, through some specific chemical reactions, is able to verify the presence of antigens (molecules that “inform” the antibodies of infections) of scarlet fever, confirming or dismissing the suspicion.

The result of this test is ready in half an hour, but in cases of an outbreak in schools, for example, it is necessary to pay attention to the symptoms, as the test can give a false negative.

Is there a cure?

Yes , with the proper treatment, scarlet fever is curable. It involves the use of antibiotic medications to control the infection and, if necessary, medications that relieve symptoms.

However, if not treated properly, the disease can lead to serious complications, such as pneumonia and arthritis .

What is the treatment?

Scarlet fever is treated with the use of antibiotics. Antibiotics are drugs that kill bacteria and help the body’s immune system fight the infectious agent.

Be sure to do the full treatment, taking the medication for the amount of days indicated in the prescription. Thus, the treatment will be more efficient, in addition to preventing the appearance of superbugs.

Other forms of treatment seek to reduce symptoms. In that case, the use of fever and pain medications can be used. However, remember to always consult a doctor before taking any other medication to avoid possible drug interactions that may affect the effectiveness of the antibiotic.

During the treatment period, it is also important to be aware of symptoms of dehydration, so be sure to drink plenty of water.


The main medication used by the medical team to treat scarlet fever is antibiotics. They are only sold with a prescription and the active ingredient to be used may vary according to the medical indication.

Among the main ones used to treat scarlet fever, we can highlight:

  • Phenoxymethylpenicillin ;
  • Amoxicillin ;
  • Benzylpenicilina benzatina ( benzetacil );
  • Azithromycin ;
  • Erythromycin ;
  • Cephalotin .

The drugs indicated for the treatment of symptoms cannot always be taken by children. If so, consult your doctor before administering. Among those used to treat symptoms, we can highlight:

  • Paracetamol (Tylenol);
  • Ibuprofeno (Advil, Motrin).

The aspirin ( acetylsalicylic acid ) should not be used, regardless of age, because as scarlet fever cause fever, the use of this drug increases the chances of developing Reye’s syndrome, a complication which, although rare, can cause liver damage and the brain.


NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Home Remedies

There are some home treatments that can be done to relieve the symptoms caused by scarlet fever.

To improve symptoms in the throat, it is possible to:

  • Gargle with water and salt;
  • Take teas that help with throat recovery, such as sage tea;
  • Eat only pasty foods or soup.

In the case of skin peeling, the application of petroleum jelly or mineral oil on the spot can help to relieve symptoms. Exposure to sunlight should also be avoided so as not to make symptoms worse.

It is worth remembering that, before using these home remedies, you should consult a doctor to check whether or not there is a chance of drug interaction and to evaluate the risks and benefits of these treatments.

How to care for the baby or child with scarlet fever?

As soon as the first symptoms appear, consult a doctor so that treatment can be started as soon as possible. Normally, 24 hours after the end of treatment, it is already possible for the child to return to their normal routine.

Children and babies with scarlet fever should not go to school, as, while not yet cured, they pose a risk of contamination for other children.

Therefore, she should stay at home, in intense rest, avoiding contact with other children.

One of the major problems with scarlet fever is the sore throat caused by the disease. One way to prevent these symptoms from getting worse is to prioritize soft and pasty food.

Therefore, give preference to porridges, cooked fruits, cereals, soups and purees. Another interesting measure to be highlighted if your child has scarlet fever is to inform the school. In this way, it is possible to help prevent outbreaks of this disease.

Upon learning of this information, the school will usually request throat examinations from other students, because when outbreaks occur, there is a high chance of an asymptomatic infected person.

Through this simple throat exam, it is possible to check if there is any case like this, as it is possible to observe the presence of Streptococcus pyogenes in the throat or nose of children.

Scarlet fever in pregnancy

Women are usually more vulnerable to infections in the early stages of pregnancy. However, there is little evidence that scarlet fever causes harm to the baby during pregnancy.

Even so, if you suspect you have this problem, talk to your doctor right away.

As in the case of any other infection, it is important that the pregnant woman be aware of possible problems and, more importantly, do not start any type of treatment without medical approval .

Living together

Living with scarlet fever can be quite complicated, since the symptoms caused by the disease are usually quite uncomfortable. There are, however, some ways to make this process less painful.

First of all, stay true to the treatment indicated by the doctor. If, in the prescription, he indicated that you should be taking antibiotics for 10 days, always take antibiotics at the right time for all 10 days.

Do not stop the treatment before its end, as this type of practice can worsen the infection, since it increases the chances of the appearance of superbugs (bacteria resistant to common antibiotics).

Other things you can do to alleviate symptoms and optimize the recovery process are:

  • Eating soft foods or adopting a liquid diet if the swallowing process is painful;
  • Drink hot teas and soups to help your throat recover;
  • If necessary, talk to your doctor to see if you can use medications like ibuprofen or paracetamol for pain relief;
  • If necessary, talk to your doctor to see if there is a possibility to use topical medications that relieve itching;
  • Drink plenty of water, to stay hydrated and to relieve throat irritation;
  • If necessary, talk to your doctor to see if you can use lozenges to relieve sore throat;
  • Keep away from substances that can make irritation worse, such as cigarette smoke or air pollution;
  • Do not smoke;
  • If necessary, you can try gargling with salt and water to relieve sore throat;
  • Use an air humidifier to prevent further throat irritation due to dry air.


The prognosis for scarlet fever, when identified at the right time and with the proper treatment, is good. Adults or children infected with Streptococcus can usually heal without major difficulties with the use of antibiotic medications.

However, if the disease is not treated correctly, it can bring serious complications to the functioning of the heart and kidneys.


Among the complications that can happen due to infection by Streptococcus pyogenes , we can highlight:

Rheumatic fever

Rheumatic fever is a type of inflammatory disease that affects patients after infections caused by Streptococcus bacteria . This complication can affect joints, skin and vital organs, such as the heart.

Among the symptoms of rheumatic fever, we can highlight:

  • Fever;
  • Joint sensitivity and pain;
  • Swelling, heat and redness in the joints
  • Small nodules appear under the skin;
  • Chest pain;
  • Heart murmur (when the heart’s blood passes through holes that it shouldn’t have);
  • Fatigue;
  • Migratory arthritis (the symptoms disappear from one part of the body to affect another part, previously healthy);
  • Lack of air;
  • Carditis (inflammation of the heart muscles).


Glomerulonephritis is the inflammation of the glomerulus, a part of the kidney formed essentially by capillaries, where blood is filtered and urine is formed.

Glomeruli are the part of the kidney that removes excess fluids, electrolytes and waste from the blood, turning them into urine. When they are inflamed, there is glomerulonephritis, which causes symptoms such as:

  • Abnormal color of the urine (pink or darker);
  • Foamy urine (due to excess protein);
  • Hypertension;
  • Fluid retention (edema), causing swelling in the face, hands, feet and abdomen;
  • Fatigue.

Ear infections

One of the possible complications of scarlet fever is ear infections, usually caused by bacteria. Among the main symptoms we can highlight ear pain , difficulty sleeping, loss of balance, high fever, headache and loss of appetite.

Throat abscess

Throat abscesses are caused by bacterial infections and cause symptoms such as difficulty and pain when swallowing, as well as fever. In addition, the abscess can block the airways, making breathing more difficult and noisy, especially when breathing in the air.


Pneumonia is a type of infection that settles in the lungs and can affect the region of the pulmonary alveoli, causing high fever, dry cough or yellowish or greenish phlegm, shortness of breath and difficulty in breathing.

Scarlet fever, by affecting the respiratory system, makes it more vulnerable to other infections, which can cause pneumonia.


Arthritis is an inflammation in the joints that causes pain, stiffness and swelling in the affected places. One of the causes of arthritis are infections and inflammatory processes that affect the joints, causing the symptoms. Among the infections that can cause arthritis is scarlet fever.

How to prevent scarlet fever?

As it is an infectious disease passed from person to person, there are measures that must be taken both by those who are healthy and by people already infected. Check out:

How not to get scarlet fever?

To avoid getting scarlet fever, there are some preventive measures you can take. Among them, we can highlight:

  • Avoid bringing your hands to your mouth or nose;
  • Wash your hands with soap and water frequently;
  • Do not share cutlery, glasses, clothing, bath towels or any other personal use.

How not to transmit scarlet fever?

If you are already infected with scarlet fever, there are some steps you can take to avoid spreading the disease to others. Are they:

  • Wash your hands frequently with soap and water;
  • Use handkerchiefs when coughing or sneezing;
  • Throw used handkerchiefs away as quickly as possible;
  • Do not share glasses, towels, cutlery or clothing with other people.

Environmental measures to prevent scarlet fever

There are also some environmental hygiene measures that can be taken to prevent the spread of scarlet fever in the school environment. Are they:

  • Caring for the cleanliness and dryness of the environment;
  • Ensure good ventilation inside the rooms;
  • At least once a day, clean and disinfect toys, furniture, flooring and places where children’s hands have frequent contact;
  • Properly disinfect materials and places contaminated by secretions or excrement;
  • Ensure that there is gel alcohol, liquid soap and paper towels or hand dryers in the bathrooms.

Common questions

How long does scarlet fever last?

Typically, the symptoms of scarlet fever tend to last for a week. Initially, they present as inflammation in the throat and fever, and the rashes start to appear around 12 to 48 hours after the initial symptoms, disappearing after approximately 7 days.

Once the rashes subside, the affected areas can begin to peel. This peeling is more common on the fingertips, feet and groin, and can last up to 6 weeks.

What is the transfer period?

As soon as the first symptoms start to appear, the patient can already transmit the disease. untreated and uncomplicated cases, the period during which the patient can transmit the disease for 10 to 21 days.

However, in cases where the patient is treated properly, the patient continues to transmit the disease for 24 hours after the start of treatment.

Can my child go to school with scarlet fever?

No . It is necessary for the child to stay at home, not only because of the symptoms, which may bring the need for him to be bedridden, but because it is necessary to avoid transmission to other children.

Even so, you don’t have to stay out of school for long. Usually, after 24 hours after the start of antibiotic treatment, if there are no more symptoms, the child can go back to school.

However, to ensure the safety of other children and your child, always talk to a doctor first.

Can adults get scarlet fever?

Despite being more common in children between 5 and 15 years old, adults are also at risk of being infected by scarlet fever, especially if they are very exposed to infected people.

Can you get scarlet fever more than once?

Scarlet fever usually occurs in children between 5 and 15 years old because their immune system is not developed enough to cope with the disease. For this reason, once scarlet fever is contracted, it is difficult to contract again. However, although rare, this can happen .

Today you learned more about scarlet fever, how it is transmitted and what to do to prevent more people from becoming infected.

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