Should I use this page, or skip it?
Use this page if a child has a sore throat, fever and a rough rash and you need a GP, school rules, and red flags. Skip it and call 999 if they are struggling to breathe, having a fit, or very hard to wake. This is a GP-antibiotic illness, not a pharmacy-first pathway like some sore throats.
Phone the surgery before you sit in the waiting room — it spreads easily.
What is scarlet fever and what does it look like?
Scarlet fever is a contagious streptococcal infection, mainly in young children. It often starts with fever, sore throat and swollen neck glands. A fine sandpaper rash appears 12 to 48 hours later on the chest and tummy, then spreads. Colour can be harder to see on brown and black skin — feel for roughness.
See rashes in children if you are not sure. Chickenpox and slapped cheek look different. A rash that does not fade under a glass is 999, not scarlet fever as usual.
Do they need antibiotics?
Yes. A GP will usually prescribe antibiotics. They help recovery, reduce spread, and lower the chance of rare complications. Follow the course you are given even if they feel better. A pharmacist can advise on paracetamol or ibuprofen for fever — follow the pack — and soothing the itch.
Find a GPhC-registered pharmacy on Pick My Pharmacy for pain relief, not as a substitute for the GP prescription. Do not use leftover antibiotics from last winter’s throat.
When can they go back to school?
Stay off nursery, school or work for 24 hours after the first antibiotic dose. NHS advice is that you can spread it until then. Without antibiotics you can spread it for two to three weeks. Wash hands, use tissues, and do not share cups, towels or bedding.
They can still feel tired after they are allowed back. Feeling too unwell to take part is a reason to stay home even after the 24 hours. Tell the setting it was scarlet fever so contacts can watch for symptoms.
How can I look after them at home?
Offer cool fluids and soft foods if swallowing hurts. Rest. Pharmacy pain relief can take the edge off fever and throat pain — follow the pack. Calamine or an antihistamine from a pharmacist may ease itch. Keep them comfortable rather than chasing a perfect temperature.
Do not give aspirin to children under 16. If they also seem to have chickenpox spots, phone the GP — having both at once needs a clinician, not two overlapping home plans.
When is it 111 or 999?
Use 111 if they are not drinking, have not passed urine for 12 hours, or seem much more unwell than a typical sore throat. Call 999 for severe breathing difficulty, a fit, confusion, or being very hard to wake. See a GP again if they do not improve in a week or become ill again weeks later.
In England, Scotland and Wales call 111 (NHS 24 in Scotland). In Northern Ireland there is no general 111 — use GP out-of-hours on nidirect. See pharmacy, GP, 111 or A&E if you are stuck on the door.
How is scarlet fever different from other childhood rashes?
Chickenpox is itchy spots that blister then crust. Hand, foot and mouth is mouth ulcers plus spots on hands and feet. Slapped cheek is a viral red-cheek rash. Measles is a different, more unwell picture in an unvaccinated child. Scarlet fever is bacterial, with a sandpaper rash and sore throat, and needs antibiotics.
If you cannot tell, phone a GP or 111 rather than guessing from a photo. A rash that does not fade under a glass is 999, not a comparison chart. Having scarlet fever and chickenpox at the same time also needs a GP, not two overlapping home plans.
Who should skip this page?
Skip this page if breathing, a fit, or unresponsiveness is already happening — call 999. It is not a viral-rash gallery, not a tonsillitis wait-and-see night, and not a Pharmacy First sore-throat pathway. Recurrent or complicated illness after scarlet fever belongs with a GP, not another bottle of calamine.
Common questions about scarlet fever
- What does the scarlet fever rash look like?
- It is a fine, raised rash that feels like sandpaper, starting on the chest and tummy then spreading. On white skin it looks pink or red; on brown and black skin the colour change can be subtle, but you can still feel the bumps. Cheeks may look flushed. The tongue can become red and bumpy after a white coating peels.
- Is scarlet fever contagious?
- Yes. It spreads through coughs, sneezes and close contact. You can spread it until 24 hours after the first antibiotic dose. Without antibiotics you can spread it for two to three weeks. Stay off nursery, school or work for 24 hours after that first dose and until they feel well enough.
- Why are antibiotics needed for scarlet fever?
- It is bacterial, so antibiotics help you recover faster, make it less likely you pass it on, and reduce the chance of rare complications. Follow the course you are given even if they feel better. Do not use leftover antibiotics from a previous sore throat. A pharmacist can help with pain relief alongside the GP prescription.
- How is scarlet fever different from a viral rash?
- Scarlet fever usually comes with a significant sore throat, fever and a sandpaper rash. Chickenpox is itchy spots that blister. Hand, foot and mouth is mouth ulcers plus spots on hands and feet. Slapped cheek is a red-cheek viral rash. If you are unsure, see a GP rather than guessing from photos — and phone ahead.
- Can adults get scarlet fever?
- Yes, though it is less common. Adults with a severe sore throat and sandpaper rash should see a GP. There is no evidence it harms a baby if you get it in pregnancy, but you can feel very unwell — avoid close contact with known cases and contact a GP if you develop symptoms.
- What if we get ill again weeks later?
- Most children recover in about a week. If they become unwell again weeks after scarlet fever, see a GP — rare complications can appear later. Having scarlet fever and chickenpox at the same time also needs a GP. Do not wait for the rash to peel; peeling as it fades can be normal.