Can Scarlet Fever Go Away on Its Own?

Scarlet fever, a bacterial infection, can cause a sore throat and red rash. Scarlet fever usually requires antibiotic treatment.

Scarlet fever is a bacterial infection that causes a red rash and often a sore throat. Scarlet fever is caused by the same bacteria that cause strep throat. It can cause serious complications, so antibiotic treatment is recommended for everyone with this infection.

What Are Symptoms of Scarlet Fever?

Symptoms of scarlet fever include:

• Rash 
  • Usually starts on the head and neck and spreads to the trunk of the body, the arms, and legs
  • Often looks like a sunburn at first (where the name “scarlet” originates)
  • Red spots that turn white when the skin is pressed
  • Small, raised bumps
  • Skin might feel rough, like sandpaper
  • Peeling skin when the rash is going away
• Bright red tongue with small bumps on it (strawberry tongue)
• Symptoms of strep throat
  • Sore throat that can start suddenly
  • White patches in the back of the throat
  • Swollen glands in the neck
  • Fever

Symptoms of scarlet fever usually go away in two to five days.

Scarlet fever is caused by group A Streptococcus or group A strep bacteria. This type of bacteria lives in the nose and throat and is spread through respiratory droplets when an infected person coughs or sneezes. In rare cases, group A strep can be spread through improperly handled food.

The incubation period for scarlet fever ranges from 12 hours to one week from exposure. Scarlet fever is contagious from the time of infection when a patient may have no symptoms, through the acute illness.

Scarlet fever is diagnosed with a physical exam where the doctor will look at the rash.

Tests used to diagnose scarlet fever include: 

• Throat or nasal culture or rapid streptococcal test
• Anti-deoxyribonuclease B, antistreptolysin-O titers (antibodies to streptococcal extracellular products), antihyaluronidase, and antifibrinolysin

Antibiotics are used to treat scarlet fever. While the illness can go away on its own, untreated scarlet fever can lead to complications including a serious disease called acute rheumatic fever which can damage the heart, so treatment is recommended. 

Medications used to treat scarlet fever include: 

• Penicillin or amoxicillin (first choice)
• Cephalosporin antibiotic (second choice)
• Clindamycin or erythromycin (alternative, though some strains of group A streptococci may not be susceptible to these types of antibiotics)

Complications of scarlet fever are rare due to antibiotic treatments, but can occur if the bacteria spread to other parts of the body. 

Complications of scarlet fever may include:

• Abscesses around the tonsils
• Swollen lymph nodes in the neck
• Ear, sinus, and skin infections
• Pneumonia 
• Rheumatic fever (heart disease)
• Post-streptococcal glomerulonephritis (kidney disease)
• Arthritis
• Meningitis
• Septic shock with multisystem organ failure (very rare)

There is currently no vaccine available for group A streptococci. To prevent the spread of the bacteria, children diagnosed with scarlet fever should not return to school or daycare until they have completed 24 hours of antibiotic therapy and symptoms are improving.