Sandpaper rash, strawberry tongue, sore throat. One of the few childhood rashes that genuinely needs antibiotics.
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Scarlet fever is caused by Group A streptococcus, the same bacterium that causes strep throat. Some strains release a toxin that produces the characteristic rash.
It is one of the few common childhood rashes that genuinely needs antibiotics — not because the illness is usually severe, but because treatment shortens it, reduces how long the child is infectious, and lowers the risk of the complications that follow untreated streptococcal infection.
It mostly affects children between two and eight, and it comes in waves through late winter and spring.
It is also a notifiable disease in the UK, meaning the diagnosing clinician must report it to public health. That is not a formality — it is how outbreaks in schools and nurseries are picked up, and it is part of the surveillance that follows invasive Group A strep infection.
The illness usually starts with a sore throat and fever, with the rash following 12 to 48 hours later.
The redness may be very difficult to see, and scarlet fever is more often missed. Feel for the sandpaper texture, look at the tongue, and check the skin creases — those three do not depend on seeing red.
Scarlet fever can be caught more than once, because different strains produce different toxins.
Scarlet fever is diagnosed on the pattern rather than on a test: sore throat and fever, followed by a sandpaper rash, with strawberry tongue and the flushed-cheeks-pale-mouth appearance.
The texture of the rash is the most useful single feature, and it is one you can check yourself — run a hand lightly over the tummy or chest.
Scarlet fever assesses well remotely with good photographs and a clear history — see our guide to photographing a skin problem. Photograph the tongue, the skin creases and the trunk.
A child who is becoming rapidly more unwell, is very drowsy, is breathing fast, or has severe pain out of proportion to what you can see. Those raise the possibility of invasive Group A strep, which is uncommon but serious and moves quickly.
Call 999 or go to A&E if your child:
Seek same-day assessment if:
Ten days is the standard course, and completing it matters more here than in most infections. The child usually feels better within a couple of days, which is exactly when courses get abandoned.
The full course is what reduces the risk of the delayed complications of streptococcal infection — rheumatic fever and kidney inflammation — which are rare in the UK precisely because the illness is treated properly.
Scarlet fever following chickenpox deserves a low threshold for review. Broken skin from chickenpox is a route in for streptococcus, and that combination is associated with more serious infection.
For an unwell child, your NHS GP or 111 is the appropriate route, and for anything urgent it is the only one. We would rather say that than take a booking.
Notification to public health happens either way — it is a legal duty on the diagnosing clinician, NHS or private.
This page follows NICE Clinical Knowledge Summaries on scarlet fever and UKHSA guidance on Group A streptococcal infection.
UKHSA has issued repeated guidance following periods of increased invasive Group A streptococcal infection in children. The features that should prompt urgent assessment are rapid deterioration, severe pain disproportionate to appearance, high fever with breathing difficulty, and reduced responsiveness.
Reviewed against NICE CKS and UKHSA guidance current at the date shown above.
Feel it. The rash is finely rough, like sandpaper — viral rashes are usually flat and blotchy.
Add strawberry tongue and flushed cheeks with a pale ring around the mouth, and the combination is fairly distinctive.
Yes. This is one of the few childhood rashes where antibiotics are clearly indicated.
They shorten the illness, reduce infectiousness within 24 hours, and lower the risk of the delayed complications.
Because the length of the course is about preventing rheumatic fever and kidney inflammation, not about symptoms.
Those complications are rare in the UK because courses are completed — which is the whole argument for finishing it.
24 hours after the first dose of antibiotics, provided they are well enough.
Do tell the school — they may be tracking a cluster.
Yes, though it is much less common. Adults more often get strep throat without the rash.
Parents and carers of an affected child do sometimes catch it, and the same treatment applies.
Yes. Different strains produce different toxins, so immunity to one does not protect against another.
That is normal and expected — peeling of the fingertips, toes and groin follows the rash and can appear well after the illness has settled.
It is not a sign of anything going wrong and needs no treatment.
A child who gets rapidly worse, especially after seeming to improve. Severe pain in a limb, fast breathing, drowsiness, or a spreading painful area of skin.
Those are the signs of invasive infection, and they warrant 999 rather than a call back.
Yes — it is a notifiable disease and the clinician who diagnoses it must inform public health.
That is how outbreaks in schools get spotted, and it happens whether you are seen privately or on the NHS.
August 30, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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