Scarlet fever rash with no fever

Scarlet fever is linked to a streptococcal throat infection and commonly appears with a rough, sandpaper-like rash. Some people may have a mild or unrecognised fever, while others have a rash caused by a different infection, irritation, allergy, or medicine. A clinician will consider the rash texture, where it began, how quickly it spread, and whether there is a sore throat, swollen glands, headache, or feeling unwell. A rash is not proof of scarlet fever, and its appearance should be assessed in context.

Take a clear photograph in good light and note when the rash appeared, whether it itches, and any new foods, products, or medicines. Arrange a medical assessment if the rash is spreading or accompanied by a sore throat or swollen glands. The clinician may examine the throat and decide whether testing for strep infection is appropriate. Do not use leftover antibiotics or share them. If scarlet fever is diagnosed, follow the prescribed treatment and hygiene advice; see Antibiotic Treatment for general information.

Seek urgent medical help for trouble breathing, swelling of the lips or tongue, faintness, severe weakness, a rapidly worsening rash, blistering, skin peeling over large areas, or purple spots that do not fade when pressed. A child who is unusually sleepy, difficult to wake, or unable to drink needs prompt assessment. Fever is not required for a rash to need medical attention.

Ask whether the rash looks consistent with scarlet fever, whether a throat test is needed, and which warning signs should prompt reassessment. Mention recent medicines, known allergies, and any contact with someone diagnosed with Strep Throat.