Scarlet fever: symptoms, treatment and when to get help

A clinician may examine the throat and rash and use a throat swab or rapid test to check for group A streptococcal bacteria. Other infections can also cause fever with a rash, so appearance alone is not enough to confirm the diagnosis.

The illness often includes a painful red throat, swollen neck glands and fever. A fine rash may feel like sandpaper and can look more intense in skin folds. On darker skin, the colour change may be subtle, but the raised rough texture can still be felt. The tongue may first have a pale coating and later become red and bumpy. Peeling around the fingers or toes can occur as the rash settles.

Scarlet fever develops when group A streptococcal bacteria produce a toxin, commonly alongside a throat infection. It spreads through respiratory droplets and close contact with contaminated secretions.

Arrange a prompt appointment, and tell the clinic about the fever and rash before arriving so staff can reduce exposure to others. Give prescribed antibiotics exactly as directed and complete the course unless the prescriber changes the plan. Do not share leftover antibiotics.

Rest, offer frequent fluids and choose cool, soft foods if swallowing hurts. A pharmacist or clinician can advise which fever or pain medicine is suitable for the person's age, medical conditions and current medicines. Wash hands, avoid sharing cups or cutlery, and follow the clinician's advice about returning to nursery, school or work after treatment begins.

Seek emergency help for difficulty breathing, blue or grey lips, severe drowsiness, confusion, a seizure, inability to swallow saliva, or swelling of the face, lips or tongue after an antibiotic. A rash that does not fade when pressed, especially with marked illness, also needs emergency assessment.

Contact a clinician urgently if the person is drinking very little, passing much less urine, repeatedly vomiting, becoming worse, or not improving after treatment starts. New joint swelling, dark urine, facial puffiness or renewed fever after apparent recovery also warrants medical review.

Ask whether testing is needed, when the person can return to shared settings, what to do after a missed antibiotic dose, and which symptom medicines are suitable. Mention medicine allergies, pregnancy, kidney problems and any close contact who is medically vulnerable.