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Scarlet fever

Last reviewed: 4 Nov 2023
Last updated: 04 Apr 2023



History and exam

Key diagnostic factors

  • scarlatiniform rash
  • fever (>100.4°F [>38.0°C])
  • sore throat
  • tonsillopharyngeal inflammation
  • tonsillopharyngeal exudate
  • palatal petechiae
  • anterior cervical adenitis
  • no cough
  • pyoderma
More key diagnostic factors

Other diagnostic factors

  • strawberry tongue
  • skin desquamation
  • headache
  • nausea
  • vomiting
  • abdominal pain
Other diagnostic factors

Risk factors

  • group A streptococcus (GAS) pharyngitis
  • close contact with a person with scarlet fever or other group A streptococcus (GAS) presentation
  • age 1-10 years
  • winter and spring seasons
  • crowded environment
  • close contact with children ages 1-10 years
  • nonpharyngitis group A streptococcus (GAS) infection
More risk factors

Diagnostic investigations

1st investigations to order

  • rapid antigen detection test (RADT) for group A streptococcus (GAS)
More 1st investigations to order

Investigations to consider

  • bacterial culture (throat, skin, wound)
  • polymerase chain reaction for group A streptococcus (GAS)
More investigations to consider

Treatment algorithm


all patients



Alexandra Brugler Yont​s, MD

Attending Physician

Pediatric Infectious Diseases

Children's National Hospital

Assistant Professor of Pediatrics

The George Washington University School of Medicine and Health Sciences




ABY is employed full-time as a Pediatric Infectious Diseases physician by Children's National Hospital. As an Investigator, her department has received institutional grant money (not in the form of salary support) for clinical trials (unrelated to the article topic) sponsored by Pfizer and ContraFect, for which there is no contractual agreement to disseminate product information. ABY has given one lecture to a local noncommercial, nonprofit, pediatrics organization (Northern Virginia Pediatric Society) at their quarterly meeting and briefly discussed the topic of streptococcal pharyngitis diagnosis and management (but did not discuss the article topic specifically). ABY has given educational talks to outside organizations unrelated to the article topic. ABY has received digital media equipment for use during a media briefing panel on the topic of the impact of the COVID-19 pandemic on children, which was organized by SciLine, a service based out of the American Association for the Advancement of Science.

Peer reviewers

Monika Dietrich, ​MD, FAAP

​Assistant Professor of Pediatrics

Section of Pediatric Infectious Disease

Children's Hospital New Orleans

Tulane University School of Medicine


New Orleans



MD declares that she has no competing interests.

Theresa Lamagni​, BSc MSc PhD

Head of Gram Positive Infection

Healthcare-Associated Infection & Antimicrobial Resistance Division

UK Health Security Agency (UKHSA)




TL declares that she has no competing interests.

  • Scarlet fever images
  • Differentials

    • Kawasaki disease
    • Erythema infectiosum (parvovirus B19, fifth disease)
    • Rubella
    More Differentials
  • Guidelines

    • Scarlet fever: information for clinicians
    • Group A streptococcal (GAS) pharyngitis: a practical guide to diagnosis and treatment
    More Guidelines
  • Patient leaflets

    Sore throat


    More Patient leaflets
  • Calculators

    Sore Throat (Pharyngitis) Evaluation and Treatment Criteria (McIsaac)

    More Calculators
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