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Symptoms of Scarlet Fever

Key points

  • Skin rash and sore throat are common symptoms of scarlet fever.
  • Physical signs of scarlet fever can appear on the tongue or skin and in the throat or neck.
  • Complications aren't common after scarlet fever.
Male doctor examining little girl's throat with a tongue depressor

Signs and symptoms

General symptoms

Some symptoms of scarlet fever are common to other infections, too. These may include:

  • Fever (101°F or higher) or chills
  • Headache or body aches
  • Nausea or vomiting
  • Sore throat and pain when swallowing
  • Stomach pain

Physical signs

Some physical signs are typical of scarlet fever. They show in the following areas:

  • Skin
  • Tongue, throat, and neck

Skin

Signs of scarlet fever on the skin include:

  • A red rash that feels rough like sandpaper
  • Brighter red skin in the creases of the underarm, elbow, and groin
  • Pale area around the mouth
  • Skin peeling as the rash fades
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Illustration of a scarlet fever rash on a small child.
The rash from scarlet fever appears brighter in skin creases.

Tongue, throat, and neck

Signs in these areas include:

  • Early in illness: Whitish coating on the tongue
  • Later in illness: "Strawberry" (red and bumpy) tongue
  • Red and swollen tonsils
  • Swollen lymph nodes in the front of the neck
  • Tiny, red spots on the roof of the mouth, called petechiae
  • Very red throat
  • White patches or streaks of pus on the tonsils
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Symptom of scarlet fever include a white tongue, red throat, swollen tonsils, and swollen lymph nodes.
First the tongue may look whitish.
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Symptom of scarlet fever include a red and bumpy tongue, red throat, swollen tonsils, and swollen lymph nodes.
Later, the tongue may look red and bumpy.

How symptoms change over time

Rash appears and spreads

One to 2 days after the illness begins, a red rash usually appears. However, the rash can appear before illness or up to 7 days later.

The rash may first appear on the neck, underarm, and groin (the area where the stomach meets the thighs). Over time, the rash spreads over the body. The rash usually begins as small, flat blotches that slowly become fine bumps that feel like sandpaper.

Color of skin can vary

Although the cheeks might look flushed (rosy), there may be a pale area around the mouth. Underarm, elbow, and groin skin creases may become brighter red than the rest of the rash.

Rash fades and skin may peel

The rash from scarlet fever fades in about 7 days. As the rash fades, the skin may peel around the fingertips, toes, and groin area. This peeling can last up to several weeks.

Complications

Complications can occur after having scarlet fever but aren't common. This can happen if the bacteria spread to other parts of the body.

Complications can include:

Treatment with antibiotics can prevent most of these health problems.

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Content Source:
National Center for Immunization and Respiratory Diseases; Division of Bacterial Diseases