Knowledge Centre
Providing rapid medical guidance and expert health insights for informational purposes. Our guides come from a Harley Street clinic, but they do not replace a professional consultation.
Scarlet fever: symptoms, rash and treatment in children
Written by Mr Stephen Lingam · Reviewed by Dr Mohammad Bakhtiar (GMC 4694470) on 25/09/2026
Key takeaways
- Scarlet fever is a group A strep infection that mainly affects children aged 2 to 8, with a rash that feels like sandpaper.
- Antibiotics clear it quickly, and children can usually go back to school 24 hours after starting them.
- Our paediatric GP clinic sees children aged 3 months to 15 years on Monday and Wednesday, 10:00 to 14:00, for £200.
- Adults and young people aged 16 and over can book a standard private GP appointment for £150.
Your child came home from school with a sore throat and a temperature. By the next morning there's a rash across their chest, and when you run your hand over it, it feels rough, like fine sandpaper.
That combination usually means scarlet fever, a bacterial infection caused by group A streptococcus (GAS), the same bacteria behind strep throat. It mainly affects children aged 2 to 8. With antibiotics it clears quickly, and complications are rare.
If you'd like a doctor to see your child, our paediatric GP clinic at 117a Harley Street runs on Monday and Wednesday, 10:00 to 14:00, for children aged 3 months to 15 years. The consultation is £200, isn't limited by a fixed clock, and walk-ins are accepted during clinic hours, though booking ahead keeps waiting short.
What does the scarlet fever rash look like?
The rash usually starts on the chest and stomach, then spreads to the arms, legs and neck. On brown or black skin it can be harder to see, but it still feels rough to the touch, which is the most useful test at home.
The face looks flushed while the skin around the mouth stays pale; doctors call this circumoral pallor. The tongue often has a white coating at first, which peels to leave a red, bumpy "strawberry tongue".
How scarlet fever usually unfolds
| When | What you may notice |
|---|---|
| 2 to 5 days after contact | Incubation period: no symptoms yet |
| Day 1 | Sore throat, temperature of 38°C or above, headache, swollen neck glands, sometimes nausea and aches |
| 12 to 48 hours later | Rough, sandpaper-like rash on the chest and stomach, spreading outwards; white then strawberry tongue |
| About a week | The rash fades |
| Following 1 to 2 weeks | Skin may peel on the fingertips, toes and groin, like peeling after sunburn. This is normal and doesn't mean your child is still infectious |
How is scarlet fever treated?
Antibiotics are the standard treatment. A 10-day course of phenoxymethylpenicillin (penicillin V) is first choice, with azithromycin or clarithromycin for children allergic to penicillin.
Antibiotics shorten the illness, reduce the risk of complications and stop your child being infectious after 24 hours. Finish the full 10-day course even once your child feels better, because stopping early raises the chance of the infection returning.
At home, paracetamol or ibuprofen helps with fever and a sore throat. Cool drinks and soft foods make eating easier, and calamine lotion or an antihistamine can ease an itchy rash.
When can my child go back to school?
NHS guidance is that children can return to nursery or school 24 hours after starting antibiotics, as long as they feel well enough. Without antibiotics, a child can stay infectious for 2 to 3 weeks.
Group A strep spreads through coughs, sneezes and close contact, and through shared cups, towels or bedding. Handwashing, tissues for coughs and sneezes, and separate cutlery all reduce spread at home.
Scarlet fever is a notifiable disease in England, so doctors report cases to UKHSA. Cases have risen since 2014, with seasonal peaks in late winter and spring. The 2022 to 2023 season was unusually large: UKHSA received 55,872 scarlet fever notifications between September 2022 and early May 2023.
Can adults get scarlet fever?
Yes, though it's much less common. Adults can catch strep throat from the same bacteria and are less likely to develop the rash. If you've been in close contact with a child who has scarlet fever and develop a sore throat and fever, a private GP appointment for adults and young people aged 16 and over is £150.
When to get urgent help
Most children with scarlet fever recover well. Invasive group A strep (iGAS) is rare but serious, so get help straight away if your child has:
- difficulty breathing or noisy breathing
- difficulty swallowing fluids, or drooling
- skin that looks mottled, very pale or bluish
- a stiff neck or reluctance to move the neck
- a high temperature that doesn't come down with paracetamol and ibuprofen
- unusual drowsiness, floppiness or reduced alertness
If your child seems more unwell than you'd expect, or is getting worse, call 999 or go to A&E. Our guide for parents on GP, NHS 111 or A&E explains the difference.
What happens at a paediatric appointment
The doctor takes a history from you, examines your child's throat and rash, and agrees a plan. One parent or legal guardian stays with your child throughout.
If a throat swab would help confirm the diagnosis, it can be taken at the clinic and sent to the laboratory for testing. There is no rapid test, and the swab is charged on top of the £200 fee, with the cost discussed first. A prescription written during the visit has no separate clinic fee; you pay the pharmacy for the medicine. A follow-up consultation for an existing paediatric patient is £150.
If your child keeps getting strep throat, or you're worried about an outbreak at school, our GPs can advise on prevention, managing it at home and when further investigation makes sense.
Sources
- Scarlet fever is caused by group A streptococcus (GAS) bacteria. It is a notifiable disease in England. Cases have increased significantly since 2014, with seasonal peaks in late winter and spring. — UK Health Security Agency — Group A streptococcal infections: surveillance data[Link]
- Scarlet fever should be treated with antibiotics to reduce symptom duration, reduce the risk of complications (peritonsillar abscess, acute rheumatic fever, post-streptococcal glomerulonephritis), and limit transmission. Phenoxymethylpenicillin (penicillin V) for 10 days is the first-line treatment. — NICE Clinical Knowledge Summary — Scarlet fever[Link]
- Children with scarlet fever should be excluded from nursery or school for 24 hours after starting antibiotic treatment. Without antibiotics, they remain infectious for 2-3 weeks. — NHS — Scarlet fever[Link]
- A total of 55,872 notifications of scarlet fever were received from week 37 of 2022 to week 18 of 2023 in England, with a pre-Christmas peak of 10,069 notifications in week 49. — UK Health Security Agency: Group A streptococcal infections, 14th update on seasonal activity in England, 2022 to 2023[Link]
Mr Stephen Lingam
Managing Director
Executive leadership
Frequently asked questions
How can I tell if it's scarlet fever or just a rash?
The scarlet fever rash feels rough, like sandpaper, and usually starts on the chest and stomach before spreading. The face is flushed but the area around the mouth stays pale, and the tongue often turns red and bumpy (strawberry tongue). A sore throat and fever with this rash strongly suggests scarlet fever.
Is scarlet fever dangerous?
With antibiotics, scarlet fever is a straightforward illness that settles within about a week, and complications are uncommon. Untreated, there's a small risk of a throat abscess (quinsy), ear infection, sinusitis and, rarely, rheumatic fever or kidney inflammation, which is why antibiotics are recommended.
Can my child see a doctor at your clinic for scarlet fever?
Yes. Our paediatric GP clinic sees children aged 3 months to 15 years on Monday and Wednesday, 10:00 to 14:00, for £200, and walk-ins are accepted during those hours. A prescription written during the visit has no separate clinic fee.
Can adults get scarlet fever?
Yes, though it's much less common, and scarlet fever mainly affects children aged 2 to 8. Adults can get strep throat from the same bacteria without the rash, so if you develop a sore throat and fever after close contact with an affected child, see a doctor, as you may need antibiotics.
How long is my child contagious?
Without antibiotics, a child can spread the infection for 2 to 3 weeks. Once antibiotics are started, they stop being contagious after 24 hours, which is why schools and nurseries usually allow them back after that, if they feel well enough.
Does the skin peel after scarlet fever?
Yes. As the rash fades, usually after about a week, the skin often peels on the fingertips, toes and groin, and this can last 1 to 2 weeks. It's normal, needs no treatment beyond moisturiser, and doesn't mean your child is still contagious.
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