Scarlet Fever: The Sandpaper Rash, Strep Testing, and Treatment
Scarlet fever is strep throat with a red, sandpaper-like rash. It's very treatable with antibiotics. Here's what to look for and when to get tested.
Scarlet fever is strep throat with a rash. It's caused by the same group A strep bacteria and is most common in children 5 to 15. Signs are a sore throat and fever, then a red rash that feels like sandpaper, often starting on the neck and chest, plus a bright red "strawberry" tongue. A rapid strep test confirms it in minutes, and antibiotics treat it. Children can usually go back to school after 12 to 24 hours of antibiotics and no fever.
Scarlet fever symptoms
- Sore throat, often sudden, with fever
- A red rash that feels like fine sandpaper, starting on the neck, chest or armpits and spreading
- Redder lines in skin folds like the elbows and armpits
- A flushed face with a pale ring around the mouth
- A red, bumpy "strawberry" tongue
- Swollen, tender glands in the neck
- Headache, stomachache, nausea or vomiting
On darker skin, the rash may be easier to feel than to see.
How it spreads
Strep spreads through coughs, sneezes and shared cups or utensils. Symptoms usually start two to five days after exposure. People are contagious until about 12 to 24 hours after starting antibiotics.
Testing and treatment
A rapid strep test from a throat swab gives a result in minutes; a negative result may be backed up with a throat culture in children. Antibiotics, usually penicillin or amoxicillin, clear the infection and prevent rare complications like rheumatic fever and kidney problems. The rash may peel, especially on the fingers and toes, for a few weeks afterward. That's normal. Our rapid strep test post has more.
What helps
- Finish the full course of antibiotics, even if your child feels better
- Fluids, soft foods, ice pops and soups
- Acetaminophen or ibuprofen for fever and throat pain, dosed by weight
- Replace toothbrushes after 24 hours of antibiotics
- Wash hands often and don't share cups
When to get seen
Come in for a sore throat with fever and a rash, or a sandpaper-like rash, or if someone at home has strep. At an AfterOurs clinic, a standard self-pay visit is $175, a visit with a rapid strep test is $250, and a self-pay in-clinic visit never costs more than $330. We contract with all major commercial and government plans, including Colorado Medicaid and Medicare. See our strep throat page and the cost and insurance page. Our post on childhood viral rashes covers other rashes with fever.
Go to the ER or call 911 if a child has trouble breathing or swallowing, is drooling, has a stiff neck, is very sleepy or confused, has a rash of purple spots that don't fade when pressed, or shows signs of dehydration such as no urine for 8 hours.
Where to find us
Four clinics across metro Denver, all ages welcome, se habla español:
- Hampden (Southeast Denver): 8 AM–11 PM daily
- Littleton: 8 AM–11 PM daily
- Thornton: 8 AM–11 PM daily
- Highlands: Mon–Fri 5–11 PM, Sat–Sun 8 AM–11 PM
Walk in, or book online.
Medically reviewed by Peter Martinuzzi, MD
This article is general health information, not medical advice for your situation. If you are worried, come in or book a telehealth visit — and if it is an emergency, call 911.