Patient information · Paediatrics
Scarlet fever and Strep A
one of the childhood rashes that always needs antibiotics
Scarlet fever is caused by group A streptococcus, the same bacterium behind most bacterial sore throats. Unlike the viral rashes of childhood, it needs a full course of antibiotics — both to shorten the illness and to prevent complications that were once common and are now rare precisely because we treat it.
Call 999 or go to an emergency department if a child
- is breathing very fast, or working hard to breathe
- has severe muscle aches or pain out of proportion to what you can see
- is very drowsy, floppy, confused or difficult to rouse
- has cold hands and feet with mottled or blue skin
- has not passed urine for 12 hours, or has no tears when crying
- has an area of skin that is rapidly becoming red, hot and severely painful
Invasive group A strep is rare but serious and can develop quickly, sometimes after chickenpox or a minor skin injury. Trust your judgement about how unwell a child looks rather than the rash itself. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
Recognising scarlet fever
- Sore throat and fever first, often with headache, vomiting and abdominal pain
- A fine pink-red rash appearing 12 to 48 hours later, typically starting on the chest and abdomen and spreading. It feels like sandpaper to the touch — the texture is more reliable than the colour, particularly on darker skin
- Flushed cheeks with a pale ring around the mouth
- A white coating on the tongue that peels to leave it red and bumpy — strawberry tongue
- The rash is more intense in skin creases, at the elbows, armpits and groin
- Skin peeling from the fingertips, toes and groin in the weeks afterwards
Treatment
- A ten-day course of antibiotics, usually penicillin. The full course matters even though the child feels better within a day or two — the point of the last days is preventing complications, not treating symptoms.
- Paracetamol or ibuprofen for fever and throat pain.
- Plenty of cool drinks; soft food if swallowing hurts.
- Calamine or an antihistamine if the rash is itchy.
- Keep fingernails short to limit scratching.
Do not give ibuprofen if there is chickenpox as well
Anti-inflammatory medicines during chickenpox are associated with severe streptococcal skin and soft tissue infection. Strep A infection following chickenpox is a recognised and dangerous combination. If your child has chickenpox and develops a fever that returns, or an area of skin that becomes red, hot and very painful, seek help urgently and use paracetamol only.
School, nursery and spread
- Children can return 24 hours after starting antibiotics, provided they are well enough.
- Without antibiotics, someone remains infectious for two to three weeks.
- Wash hands frequently, bin used tissues, and do not share cups, cutlery or towels.
- Scarlet fever is a notifiable disease — we are required to inform public health, which is how outbreaks in schools are identified and managed.
- Tell the school or nursery, particularly if other children have sore throats.
Why the full course matters
Untreated streptococcal infection can be followed by rheumatic fever, affecting the heart valves, and by a kidney condition called glomerulonephritis. Both are now uncommon in the UK, and that is a direct consequence of treating streptococcal infection properly. It is also why a child who cannot tolerate the medicine, or vomits it repeatedly, should be reviewed rather than left to see how it goes.
Book an appointment if your child has a sore throat with a rash, is not improving after 48 hours on antibiotics, develops a fever that returns after settling, or you would like a throat swab. We see children seven days a week and can swab and treat in a single visit.
Throat swabs and same-day treatment
Children seen seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.