Related Terms

  • Antibiotics, glomerulonephritis group A streptococcus, impetigo, meningitis, rash, reye syndrome, rheumatic fever, scarlatina, scarlet fever, strep throat, streptococcus pyogenes, white strawberry tongue.


  • Scarlet fever, or scarlatina, is a disease caused by the bacteria known as group A streptococcus or Streptococcus pyogenes, the same bacterium that causes strep throat. Scarlet fever is characterized by a rash.
  • Individuals who develop scarlet fever are usually under the age of 18, and are generally between the ages of five and 15. Adults rarely become infected with scarlet fever. Approximately 10% of individuals who become infected with group A streptococcus develop scarlet fever. Ethnicity and gender do not appear to be risk factors for scarlet fever.
  • If treated with antibiotics, children will usually make a full recovery in approximately 10 days. However, swollen glands and swollen tonsils may last for a few weeks. Rare but serious complications may result from untreated scarlet fever, such as rheumatic fever.

Risk Factors

  • Scarlet fever usually affects children between the ages of five and 15.
  • Outbreaks of strep throat or scarlet fever in the community, neighborhood, or school may increase a child’s risk of developing the infection.


  • Streptococcus pyogenes: The bacterium known as Streptococcus pyogenes, or group A beta-hemolytic streptococcus, causes scarlet fever. This is the same infection that causes strep throat. However, the type of bacteria causing scarlet fever releases toxins that can cause the classic symptom of the scarlet-colored rash.
  • Rare causes: Rare causes of scarlet fever include other types of the bacteria Streptococcus pyogenes associated with either impetigo (skin infection) or a uterine (organ nourishing the developing fetus prior to birth) infection contracted during childbirth. The rash and fever occur without the signs and symptoms of a throat infection.

Signs and Symptoms

  • General: The incubation period (time between exposure and developing symptoms) ranges from one to seven days. Generally, the incubation period is two to four days.
  • Fever: A common symptom is fever of 101° F or higher along with chills.
  • Flushed face: The face becomes flushed with a pale area around the lips.
  • Rash: The rash first appears on the face, neck, or upper chest as tiny, red pinpoints and usually lasts for approximately two to five days. Generally, the rash appears 12-48 hours after the fever begins, and it is not serious. Additionally, the rash may spread over most of the body within hours to days. The rash has the appearance of sunburn and feels like a rough piece of sandpaper. The rash may itch, but it usually is not painful. Once the rash disappears, the skin on the tips of the fingers and toes may peel. If the infection is caused by impetigo (skin infection), then it may spread through contact with the skin.
  • Sore throat: The throat becomes very red and sore and may have white or yellow patches resulting in difficulty swallowing, which is characteristic of strep throat. Additionally, the lymph nodes (glands in the neck) may be swollen and tender.
  • Tongue coating: The symptom known as “white strawberry tongue” manifests as a red and bumpy tongue with a white coating in the beginning of the illness.


  • General: Even with the characteristic symptoms of scarlet fever, it is important to confirm that the bacteria group A streptococcus is present by performing laboratory tests.
  • Physical exam: The doctor will examine the child’s throat, tonsils (masses of tissue located on the back of the throat), tongue, and rash to identify symptoms of scarlet fever. Additionally, the doctor will feel the child’s neck to determine whether the lymph nodes are enlarged and swollen.
  • Throat culture: The doctor will take a swab from the child’s throat, and the results are determined in approximately two days. The material taken from the throat is left to grow in a warm place. The throat culture is an extremely accurate test for determining whether group A streptococcus is present.
  • Rapid antigen test: This test can be completed during the child’s visit to the doctor’s office, and the results are determined within 15 minutes. The doctor will use a cotton swab to take material from the back of the throat. This tests for group A streptococcus. The disadvantage is that this test is less accurate than a throat culture. If the rapid antigen test is negative, then the doctor will usually order the throat culture to determine that the diagnosis is accurate.
  • Rapid DNA test: This test uses DNA technology to identify strep bacteria from a throat swab in a day or less. Additionally, this test is as accurate as a throat culture with the advantage of receiving the results more rapidly.


  • General: Serious complications may develop if patients are not treated quickly with antibiotics. Evidence suggests that receiving treatment within nine days of the first symptoms prevents the development of serious long-term complications.
  • Glomerulonephritis: Glomerulonephritis (kidney damage) may result from scarlet fever. The kidneys may lose their ability to filter fluids and waste. Dangerous amounts may build up and lead to kidney failure.
  • Meningitis: Scarlet fever may lead to meningitis (inflammation of the membranes surrounding the brain and spinal cord). Bacterial meningitis is very serious and may result in brain damage or death without treatment.
  • Rheumatic fever: Rheumatic fever is an inflammatory disease that can affect various organs such as the heart, joints, skin, and nervous system. It is a rare complication of untreated strep throat infection. When children are appropriately treated with antibiotics for strep bacteria, the risk of developing rheumatic fever is unlikely.


  • Antibiotics: Oral penicillin or amoxicillin for 10 days is the treatment of choice for scarlet fever. If the child has a penicillin allergy, then the patient should be treated with erythromycin. Side effects may include mild stomach cramps or upset, nausea, vomiting, and diarrhea. It is important that patients complete the antibiotic therapy. Children should not stop taking the antibiotic when they are feeling better or are no longer contagious. After receiving antibiotics for 24 hours, children are no longer contagious and may return to school or daycare. Parents should contact the doctor if their child is not feeling better within 24 to 48 hours after starting the antibiotic.
  • Fluids: Children infected with scarlet fever should be given plenty of fluids to keep the throat moist and prevent dehydration. Additionally, swallowing may be painful so soothing foods such as soup, ice cream, or popsicles may be beneficial. Also, applying a moist, warm towel to the child’s neck may help soothe swollen glands.
  • Over-the-counter medications: Over-the-counter medications such as ibuprofen (Motrin® or Advil®) or acetaminophen (Tylenol®) may be used to reduce fever and throat pain symptoms. Aspirin should be avoided since it has been associated with the development of Reye syndrome (sudden brain damage and liver failure linked with the use of aspirin during a viral illness) in children. Additionally, Chloraseptic spray can be used in children older than three years to relieve sore throat symptoms. Chloraseptic spray works by numbing the throat and should not be used in patients allergic to local anesthetics, such as benzocaine.

Integrative Therapies

: There is currently limited available evidence on the use of integrative therapies for the prevention or treatment of scarlet fever. The integrative therapies listed below have been studied for use in various bacterial infections, should be used only under the supervision of a qualified healthcare provider, and should not be used in replacement of other proven therapies or preventive measures.


Strong scientific evidence

  • Probiotics
    : Probiotics are beneficial bacteria and are sometimes called friendly germs. They help maintain a healthy intestine by keeping harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Probiotics can be taken as capsules, tablets, beverages, powders, yogurts, and other foods. An increasing number of studies support the use of probiotics as a supplement to antibiotic therapy. Probiotic supplementation during a course of antibiotics has been studied for reducing adverse effects of antibiotics in the intestinal environment. This includes reducing growth of Clostridium difficile bacteria, which can lead to colitis, a common complication of antibiotics, especially in the elderly. Some probiotics may also help prevent the development of antibiotic resistance. In acutely ill children, synbiotics have been linked to greater weight gain and fewer bacterial illnesses after antibiotics are ended. The evidence consistently supports supplementation of antibiotics with probiotics.

  • Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.


Good scientific evidence

  • Probiotics
    : Limited evidence with day care children suggests supplementation with Lactobacillus GG may reduce number of sick days, frequency of respiratory tract infections, and frequency of related antibiotic treatments.
    Fermented milk (with yogurt cultures and L. casei DN-114001) may reduce the duration of gastrointestinal and respiratory infections in elderly people. More research is needed to make a firm conclusion.

  • Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.


Unclear or conflicting scientific evidence

  • Blessed thistle
    : Human research of blessed thistle as a treatment for bacterial infections is currently lacking. Laboratory studies report that blessed thistle (and chemicals contained in blessed thistle, such as cnicin and polyacetylene) may have activity against several types of bacterial infections and no effects on some types. Further evidence is necessary in this area before a firm conclusion can be drawn.

  • Blessed thistle is generally considered to be safe when taken by mouth in recommended doses for short periods of time, with few reported side effects such as birth defects, bleeding, breathing problems, bruising, cancer of the nose or throat, increased production of stomach acid, itching, kidney disease, liver toxicity, skin rash, stomach discomfort, stomach ulcers, and vomiting. Allergic reactions to blessed thistle including rash may occur, as well as cross-sensitivity to mugwort and Echinacea. Cross-reactivity may also occur with bitter weed, blanket flower, Chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed or other plants in the Asteraceae/Compositae family. Avoid if pregnant or breastfeeding.
  • Cranberry
    : Limited laboratory research has examined the antibacterial activity of cranberry. Further research is warranted in this area.

  • Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Pregnant and breastfeeding women should avoid cranberry in higher amounts than what is typically found in foods.
  • Hydrotherapy
    : Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. There is preliminary evidence that some hydrotherapy techniques may reduce skin bacteria. There may be benefits in people with skin wounds or ulcers who are at risk of infection. Evidence that infection of the skin itself (cellulitis) is improved is currently lacking. More research is needed in this area.

  • Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices, such as pacemakers, defibrillators, or liver infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud’s disease, chilblains, acrocyanosis, erythrocyanosis, or impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and it should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physicians before starting hydrotherapy.
  • Lavender
    : Early laboratory studies suggest that lavender oils may have topical antibiotic activity. However, this has not been well tested in human studies.

  • Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (such as anorexia or bulimia), or anemia (low levels of iron). Avoid if pregnant or breastfeeding.
  • Prayer/distant healing
    : Prayer can be defined as a “reverent petition,” the act of asking for something while aiming to connect with God or another object of worship. Prayer may help reduce the length of hospital stay as well as the duration of fever in patients with infections. However, early study is controversial and additional study is needed before a conclusion can be drawn.

  • Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches and require an open dialog between patients and caregivers.
  • Probiotics
    : As a bacterial reservoir, the nose may harbor many varieties of potentially disease-causing bacteria. There is limited evidence that probiotic supplementation may reduce the presence of bacterial infections in the upper respiratory tract. Results are mixed regarding the ability of probiotics to reduce infective complications of medical treatment. Reduced incidence of infection has been seen in patients treated for brain injury, abdominal surgery and liver transplantation. Other studies have shown no such reduction in elective abdominal surgery and critical care patients. More studies are needed to determine the effectiveness of probiotics for these indications.

  • Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Propolis
    : Propolis is a natural resin created by bees to make their hives. Propolis is made from the buds of conifer and poplar trees and combined with beeswax and other bee secretions. Animal and laboratory studies suggest that propolis may be a beneficial treatment for various types of bacterial infections. Additional research is needed to confirm these findings.

  • Avoid if allergic or hypersensitive to propolis, black poplar (Populas nigra), poplar bud, bee stings, bee products, honey, or Balsam of Peru. Severe allergic reactions have been reported. There has been one report of kidney failure with the ingestion of propolis that improved upon discontinuing therapy and deteriorated with re-exposure. Avoid if pregnant or breastfeeding because of the high alcohol content in some products.
  • Seaweed, kelp, bladderwrack
    : Bladderwrack (Fucus vesiculosus) is a brown seaweed found along the northern coasts of the Atlantic and Pacific oceans and North and Baltic seas. Another seaweed that grows alongside bladderwrack is Ascophyllum nodosum, and
    it is often combined with bladderwrack in kelp preparations. Laboratory research suggests that bladderwrack may have antibacterial activity. However, reliable human studies to support this use are currently lacking in the available literature.

  • Avoid if allergic or hypersensitive to Fucus vesiculosus or iodine. Avoid with a history of thyroid disease, bleeding, acne, kidney disease, blood clots, nerve disorders, high blood pressure, stroke, or diabetes. Avoid if pregnant or breastfeeding.
  • Selenium
    : Selenium is a mineral found in soil, water, and some foods. Further research is needed to confirm the effects of selenium for infection prevention.

  • Avoid if allergic or hypersensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
  • Sorrel
    : There is currently not enough evidence on the proposed antibacterial effects of sorrel. More research is needed.

  • Avoid large doses of sorrel because there have been reports of toxicity and death. This may be because of the oxalate found in sorrel. Many sorrel tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. These sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl®) or disulfiram (Antabuse®). Avoid if pregnant or breastfeeding.


Fair negative scientific evidence

  • Macrobiotic diet
    : A macrobiotic diet has been advocated to preserve intestinal health. However, it apparently does not reduce the incidence of antibiotic resistant bacteria, nor infections caused by resistant strains in the gastrointestinal tract, compared to a diet with animal products.

  • Use cautiously with cancer or other medical conditions without expert planning or supplementation. Avoid in children or adolescents without professional guidance or appropriate supplementation. Avoid in pregnant or lactating women due to potential deficiencies, unless properly supplemented.
  • Probiotics
    : Bacterial infection translocation, the passage of bacteria from the gut to other areas of the body where they can cause disease, is of special concern in surgery. Limited evidence suggests that supplementation with probiotics may not reduce this problem.

  • Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.


  • Scarlet fever is contagious, and the bacteria can spread to others through sneezing and coughing.
  • Separating the infected child’s drinking glasses and eating utensils and washing them in hot, soapy water may prevent the infection from spreading to family and friends.
  • Parents of children infected with scarlet fever should wash their hands frequently.

Author Information

  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration ().


Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to Selected references are listed below.

  1. Aber C, Alvarez Connelly E, Schachner LA. Fever and rash in a child: when to worry? Pediatr Ann. 2007 Jan;36(1):30-8.
    View Abstract
  2. Centers for Disease Control and Prevention. . Accessed April 27, 2009.
  3. Festekjian A, Pierson SB, Zlotkin D. Index of suspicion. Pediatr Rev. 2006 May;27(5):189-94.
    View Abstract
  4. Hahn RG, Knox LM, Forman TA. Evaluation of poststreptococcal illness. Am Fam Physician. 2005 May 15;71(10):1949-54.
    View Abstract
  5. Hedrick J. Acute bacterial skin infections in pediatric medicine: current issues in presentation and treatment. Paediatr Drugs. 2003;5 Suppl 1:35-46.
    View Abstract
  6. Jaggi P, Shulman ST. Group A streptococcal infections. Pediatr Rev. 2006 Mar;27(3):99-105.
    View Abstract
  7. National Institute of Allergy and Infectious Diseases. . Accessed April 27, 2009.
  8. Nemours. . Accessed April 27, 2009.
  9. MedlinePlus. . Accessed April 27, 2009.
  10. Natural Standard: The Authority on Integrative Medicine. . Copyright 2008. Accessed April 27, 2009.