Scarlet fever: what the rash looks like, why antibiotics matter, and the school rules

Nausea is not the symptom here. A sore throat that comes on fast in a child, a flushed face with a pale ring around the mouth, and a rash that feels like sandpaper: that is the picture most parents describe before anyone says the words scarlet fever. It sounds like a disease from a Victorian novel, but GPs across London see it every winter and spring, and cases have been climbing in recent years. At The Online GP by The Wellness, we assess children with suspected scarlet fever by phone and video every week, and the questions parents ask are almost always the same: is it dangerous, do they need antibiotics, and when can they go back to nursery or school.

What scarlet fever actually is

Scarlet fever is a bacterial illness caused by group A Streptococcus, the same bacterium behind ordinary strep throat. Some strains release a toxin that produces the characteristic rash. It mostly affects children aged two to eight, though adults can catch it too. It spreads through coughs, sneezes and shared cups, which is why it moves through nurseries and classrooms so quickly.

The illness usually starts like a bad cold that means business: fever of 38.3C or higher, a sore throat that hurts to swallow, swollen neck glands, and sometimes headache and stomach ache. One to two days later the rash appears.

What the rash looks and feels like

The rash is the giveaway. It feels rough, like fine sandpaper, and looks like small pink-red spots that blanch when you press them. It usually starts on the chest and tummy before spreading to the ears, neck and face. The cheeks flush red but the area around the mouth stays pale, which doctors call circumoral pallor.

Two other signs clinch it. First, the tongue: it starts white with red spots (strawberry tongue), then the white coating peels leaving it red and swollen (raspberry tongue). Second, the skin folds: the creases of the elbows, armpits and groin develop deeper red lines, called Pastia lines. As the rash fades over about a week, the skin on the fingertips, toes and groin often peels, which is normal and not a sign of anything worse.

Is it dangerous?

For most children, no. With prompt antibiotics, scarlet fever is a straightforward illness that settles within a week. The reason doctors treat it promptly is not the illness itself but what untreated group A strep can occasionally do: ear infections, quinsy (a throat abscess), and, rarely, kidney inflammation or rheumatic fever. The UK has also seen periodic surges in invasive group A strep infections, which is why public health guidance is to treat suspected scarlet fever quickly rather than watch and wait.

Call 999 or go to A&E if your child is struggling to breathe, drooling because they cannot swallow, unusually drowsy or floppy, showing signs of dehydration such as no wet nappies for 12 hours, or has a rash that does not blanch when pressed with a glass.

Do children actually need antibiotics?

Yes. Scarlet fever is one of the childhood illnesses where antibiotics genuinely change the outcome. A 10-day course of phenoxymethylpenicillin (penicillin V) is first line, with alternatives such as amoxicillin or, for children allergic to penicillin, azithromycin or clarithromycin. Antibiotics shorten the illness, make children far less contagious within about 24 hours, and sharply cut the risk of complications.

A consultation with a private GP in London for a child's rash and fever typically costs £100 to £250 as a walk-in, before any prescription. A same-day phone consultation with The Online GP costs £59 for 15 minutes, and where scarlet fever is confirmed or strongly suspected, the prescription can be arranged the same day to a pharmacy near you. A video consultation costs £150 if the GP needs to see the rash properly, and an in-person appointment at our Marylebone clinic is £220.

Book a same-day phone consultation for £59 and get answers within hours, not days of waiting for a slot.

When can they go back to school or nursery?

UK Health Security Agency guidance is clear: children with scarlet fever should stay off school or nursery until at least 24 hours after starting antibiotics, and until they feel well enough. Without antibiotics they remain contagious for two to three weeks, which is one more reason prompt treatment matters. Tell the school or nursery so they can watch for other cases, and wash hands, cups and toothbrushes carefully at home.

If you are weighing up whether your child's rash needs a doctor, message us on WhatsApp with a photo and we will tell you honestly whether it needs a consultation or safe watching at home.

What parents can do at home alongside antibiotics

Paracetamol or ibuprofen for fever and throat pain, dosed for age and weight. Plenty of fluids; ice lollies and cold yoghurt often go down better than water when swallowing hurts. Soft foods. Rest. Calamine lotion or an emollient if the peeling skin itches. Keep their towel, cup and cutlery separate while they are contagious.

When to speak to a GP

Any child with a sandpaper rash and fever should be assessed the same day. Also get urgent advice if your child was treated but is not improving after 48 hours of antibiotics, develops ear pain, a new fever, or swelling on one side of the throat. Our doctors see these presentations daily and can confirm the diagnosis, prescribe, and tell you exactly when nursery or school is safe again.

Book your same-day consultation or call us on 020 3951 3429. Phone consultations are £59, video £150, and in-person at Unit 4, 10 Portman Square, London W1H 6AZ is £220.

Frequently asked questions

Can adults get scarlet fever?

Yes, though it is less common. Adults who live with or care for an infected child can catch it, and the treatment is the same: a course of antibiotics and 24 hours off work after starting them if you are feverish or contagious.

Is scarlet fever the same as slapped cheek syndrome?

No. Slapped cheek syndrome is caused by a virus (parvovirus B19), produces bright red cheeks with a lacy body rash, and needs no antibiotics. Scarlet fever is bacterial, feels like sandpaper, and always needs antibiotic treatment.

How long is a child contagious?

Without antibiotics, up to two or three weeks. After starting antibiotics, most children are no longer contagious within about 24 hours, which is when UKHSA says they can return to school or nursery if they feel well enough.

Can scarlet fever come back?

Yes. Because several strep strains produce the rash toxin and infection does not give lasting immunity, children can get scarlet fever more than once. Each episode is treated the same way.

Do I need to see a GP in person to get antibiotics?

Not usually. The combination of fever, sore throat, strawberry tongue and a sandpaper rash is often clear enough on a phone or video consultation, and UK guidance supports treating suspected cases promptly. If the picture is unclear, a video consultation lets the GP inspect the rash and tongue directly.

What if my child is allergic to penicillin?

There are effective alternatives, most commonly azithromycin or clarithromycin. Tell the GP about any previous reactions and they will choose a safe option.

References

NHS. Scarlet fever. nhs.uk, reviewed 2024.

UK Health Security Agency. Scarlet fever: guidance for schools and nurseries. GOV.UK, updated 2024.

NICE Clinical Knowledge Summary. Scarlet fever: antimicrobial prescribing. NICE, 2024.

Written by The Wellness Team and medically reviewed by The Wellness Clinical Team. This article is for information only and does not replace a consultation. If your child has a rash that does not blanch under a glass, breathing difficulty or unusual drowsiness, call 999.