Scarlet Fever: The Rash That Follows a Sore Throat
Scarlet fever is a childhood illness caused by the same bacteria that cause strep throat. It typically brings a sore throat and fever, followed by a fine, red rash that feels like sandpaper. It mainly affects children between two and ten years, and today it responds well to a short course of antibiotics.
The name sounds frightening, and a century ago scarlet fever was a serious illness, but it is now readily treatable and most children make a full recovery. It tends to appear in outbreaks, so cases often rise when the same bacteria are circulating through schools and daycare. Because it starts with a sore throat, it is closely linked to tonsillitis in children, and the rash is what sets it apart. Recognising that combination early helps your child get the right treatment quickly.
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Scarlet fever usually begins like a throat infection, with a sore throat, fever, headache and swollen neck glands. Within a day or two a rash appears, starting on the chest and tummy before spreading. It is made up of tiny red bumps that give the skin a rough, sandpaper feel, and it often looks flushed, like sunburn, and may be more obvious in skin folds such as the neck, armpits and groin.
Other clues include a flushed face with a pale area around the mouth, and a tongue that can look white and then turn red and bumpy, sometimes called strawberry tongue. As the rash fades over a week or so, the skin may peel, particularly on the fingertips. The rash can resemble other childhood rashes, so it helps to compare it with hand, foot and mouth disease if you are unsure.
Scarlet fever is caused by group A streptococcus, often shortened to strep A, the same bacteria behind many bacterial sore throats. The rash appears because some strains of these bacteria release a toxin that the skin reacts to. So scarlet fever is really strep throat with a rash, which is why the sore throat usually comes first.
The same bacteria can also cause skin infections, so a child may sometimes have impetigo, or school sores around the same time. Strep spreads easily through coughs, sneezes and close contact, which is why it moves quickly through classrooms. A fever alongside a rash always deserves attention, and our guide to when a child's fever is worth worrying about helps you judge how concerned to be while you arrange to see a doctor.
Scarlet fever is treated with a short course of antibiotics, which clears the infection, shortens how long your child is unwell, reduces the chance of spreading it to others, and lowers the small risk of complications. It is important to finish the full course exactly as prescribed, even once your child feels better, because stopping early can let the infection linger.
Alongside antibiotics, comfort measures help: regular fluids, soft foods that are easy to swallow, and simple pain relief suitable for your child's age to ease the sore throat and settle the fever. Antibiotics are not used for every childhood illness, and our clinicians explain why we don't always prescribe antibiotics, but scarlet fever is one situation where they are clearly worthwhile. Most children start to feel better within a day or two of starting treatment.
Children with scarlet fever should stay home from school or daycare until they have taken antibiotics for a full 24 hours and are feeling well. After a day of treatment they are generally no longer contagious, which is why the exclusion period is relatively short once antibiotics have started.
Exclusion rules can differ between states and territories, so check your own state's guidance or ask your child's school if you are unsure. Because a parent usually needs to stay home for at least the first day or two of care, a doctor can provide a carer's medical certificate for your workplace. Letting your child rest at home until the fever has settled and they feel well again helps them recover fully, and it protects their classmates and teachers from catching the same infection.
See the same doctor each time
Because scarlet fever needs antibiotics, see a doctor if your child has a sore throat followed by a sandpaper rash, or a fever with any rash you cannot explain. A doctor can confirm the diagnosis, sometimes with a throat swab, and start treatment. Getting in early helps your child recover faster and lowers the risk of complications.
Return to a doctor if your child is not improving after a couple of days of antibiotics, if the fever climbs again, or if they develop new symptoms such as painful joints, dark urine or worsening pain. Scarlet fever itself is rarely an emergency, but call 000 if your child is struggling to breathe or swallow, is drooling, is very drowsy or hard to wake, or their lips look blue. If a fever will not settle, our guide to childhood fever can help.
Abby Health is an online-first clinic, so you can talk to an Australian GP about your child's sore throat and rash from home, seven days a week, without a waiting room. A doctor can review the symptoms, look at the rash over video, advise whether a swab or in-person review is needed, and start treatment promptly so your child feels better sooner.
You can choose to see the same doctor each time, so your child's history is understood and any pattern of strep infections is tracked properly. If you need to stay home to care for your child, we can help with a carer's certificate for your employer. Book through our everyday family clinic when it suits you. Bulk billed for eligible patients with a valid Medicare card. Strict eligibility criteria apply. This is general information only and not a substitute for personal medical advice. If your child is seriously unwell or struggling to breathe, call 000.
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