Symptoms of scarlet fever generally take one to four days to appear after infection.
The illness often starts with a sore throat or skin infection and fever. The rash appears 12 to 48 hours after the fever.
Rash
Red blotches are the first sign of the rash. These turn into a fine pink-red rash that feels like sandpaper to touch and looks like sunburn.
The rash may start in one place but soon spreads to many other parts of the body. It commonly affects the ears, neck, chest, elbows, inner thighs and groin.
The rash does not normally spread to the face. However, the cheeks become flushed and the area just around the mouth stays quite pale. The rash will turn white if you press a glass on it.
The rash lasts for six days, then usually fades from the top of the body downwards. It usually disappears within a week. The rash may be itchy and usually occurs alongside other symptoms (see below). In milder cases, sometimes called scarlatina, the rash may be the only symptom.
Other symptoms
Other symptoms may include:
- headache
- swollen neck glands
- loss of appetite
- nausea or vomiting
- stomach pain
- broken blood vessels in the folds of the body, such as the armpit, which cause red streaks that may last a couple of days after the rash has gone (these are known as pastia lines)
- a white coating on the tongue, which peels a few days later leaving the tongue red and swollen (this is known as strawberry tongue)
- a general feeling of being unwell
If you feel very unwell, with severe muscle aches, diarrhoea or vomiting, see your doctor. This is to rule out other infections caused by streptococcal bacteria, such as toxic shock syndrome, which can be easily treated if caught early.
Outer layers of skin, usually on the hands and feet, may peel for up to six weeks after the scarlet fever rash has faded.
