Clinical Notes : Paediatrics

66. Scarlet Fever

Scarlet Fever


  • Airborne droplet spread

  • Group A Streptococcus (GAS, Streptococcus pyogenes) is a bacterium which can colonise the throat, skin and anogenital tract

  • Infections

    • Tonsillitis

    • Pharyngitis

    • Pneumonia

    • Scarlet fever

    • Impetigo

    • Erysipelas

  • Post-streptococcal complications

    • Invasive Group A streptococcus

    • Rheumatic fever

    • Glomerulonephritis

    • Cellulitis



  • Scarlet Fever is not included in the Irish HSE list of Notifiable Diseases.

  • The Post-streptococcal complication, Invasive Group A streptococcus, is included in the Irish HSE list of Notifiable Diseases. but does not appear on the HSE list of Notifiable Diseases for Immediate Preliminary Notification to a Medical Officer of Health.



  • 90% of cases occur in children under ten years old

  • It is most common in children between the ages of two and eight years with four year olds most likely to develop the illness

  • Occasionally, outbreaks of scarlet fever occur in nurseries and schools


  • Usually clinical

    • confirmation by throat swab

  • Incubation

    • 2-5 days

  • Prodrome

    • Sore throat

    • headache

    • fever

    • nausea and vomiting

  • Rash then appears

    • after 12 to 48 hours

    • characteristic red, generalised pinhead rash

    • typically first appearing on the chest and stomach, rapidly spreading to other parts of the body, giving the skin a sandpaper-like texture

    • On more darkly-pigmented skin, the scarlet rash may be harder to spot, although the “sandpaper” feel should be present

  • Pastia lines

    • The folds of skin around the groin, armpits, elbows, knees and neck usually become a deeper red than the surrounding rash.

    • may last a couple of days after the rash has gone

  • Flushed face

    • typically have flushed cheeks and pallor around the mouth

  • Strawberry tongue

    • white coating on the tongue which peels a few days later leaving the tongue looking red and swollen



  • 10-day course of penicillin.

    • Amoxicillin or clarithromycin

  • Paracetamol for aches and pains

  • Calamine lotion for itchy skin


Infection control

  • Minimise droplet spread by covering mouth and nose when coughing and sneezing

  • Bacteria can be transmitted by touching someone with a streptococcal skin infection or by sharing contaminated eating utensils, cups and glasses, clothes, baths, bed linen or towels.

  • Can return to childcare setting / work 24 hours after commencing antibiotic



  • During convalescence  peeling of the skin may occur

    • up to six weeks after the rash has faded

    • at the tips of fingers and toes

    • less often over wide areas of the trunk and limbs


Scarlet fever




Scarlet fever

Mayo Clinic



Managing scarlet fever.

Drug Ther Bull. 2017 Sep;55(9):102


Managing scarlet fever.

BMJ. 2018 Aug 30;362:k3005


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