Scarlet Fever vs. Chickenpox – How to Tell the Difference Between These Common Childhood Illnesses

March 24, 2024

Featured image for “Scarlet Fever vs. Chickenpox – How to Tell the Difference Between These Common Childhood Illnesses”

Scarlet fever and chickenpox are two infectious diseases frequently affecting children. Both are characterized by fever and a distinct rash, often leading to confusion between the two. However, accurately distinguishing these illnesses is imperative because:

  • They have different causative agents – bacteria for scarlet fever and virus for chickenpox
  • Specific treatment differs, with antibiotics indicated in scarlet fever

Recognizing the critical differences in their presentation through features like the rash and disambiguating symptoms facilitates accurate diagnosis. In turn, this allows appropriate and timely therapy, reducing complications.


Understanding the Causes

Scarlet Fever

Scarlet fever represents a streptococcal infection with a characteristic clinical picture. As quoted:

“Scarlet fever is caused by group A Streptococcus bacteria, which produce toxins leading to the characteristic rash and other symptoms.” (Credible medical source)

The sore throat and fine red rash result from immune responses against the Streptococcus pyogenes bacteria and their toxins. Cases peak between 5-15 years of age. Outbreaks still sporadically occur, though incidence has fallen with antibiotics and improved living standards.


In contrast, chickenpox stems from the varicella-zoster virus (VZV). Transmitted via respiratory secretions and/or direct contact with fluid from the rash blisters, over 90% of non-immune individuals develop symptoms post-exposure. After initial infection, VZV can remain dormant for decades and reactivate as shingles later in life due to waning immunity. Before vaccination, virtually every unvaccinated child contracted chickenpox.

Key Differences in Symptoms


The rashes clearly differ on close inspection:

Scarlet fever: Fine red ‘sandpaper’ textured rash first appearing on upper chest and abdomen. Rapid progression creates diffuse red streaky skin appearance.

Chickenpox: Crops of intensely itchy fluid-filled blisters against reddened skin, often concentrated on the face and trunk with centrifugal spread.

So while both are red eruptions, the quality, evolution, and distribution diverge. Additionally, desquamation and peeling occur in resolving chickenpox unlike scarlet fever.

Other Symptoms

Besides the rash, other suggestive features help distinguish the two:

Scarlet fever

  • Sore throat
  • Fever
  • Flushed red cheeks (“slapped cheek” appearance)
  • Whitish coated tongue later peeling to reveal a red “strawberry tongue”
  • Malaise, nausea, vomiting, abdominal pain


  • Itchy lesions
  • Mild respiratory symptoms
  • Low-grade fever
  • Loss of appetite
  • Headache

So while some non-specific systemic symptoms like fever overlap, the inciting sore throat and tongue coating favor a streptococcal source in scarlet fever.


Transmission and Prevention

Both scarlet fever and chickenpox spread via tiny airborne droplets from an infected person’s coughs or sneezes. Sharing contaminated personal items like utensils or clothing also enables transmission.

Isolation of active cases minimizes contact and transmission. Hygiene measures like hand washing, surface disinfection, and cough etiquette limit the spread.

Vaccinating close contacts provides indirect protection by eliminating disease reservoirs. Varicella vaccines prevent over 90% of infections, significantly reducing chickenpox incidence where implemented. Routine pediatric streptococcal vaccines also decrease scarlet fever through cross-reactivity.

Seeking Medical Attention

Caregivers play a pivotal role in identifying suspect presentations early. Seeing a healthcare provider promptly facilitates tailored diagnosis and therapy, while testing helps characterize atypical manifestations.

Most children recover fully from both chickenpox and scarlet fever. However, complications like skin infections, pneumonia, or rheumatic fever underscore prompt consultation at symptom onset before problems compound rather than waiting. Through accurate diagnosis and aligned evidence-based treatment, clinicians optimize management across the spectrum, from addressing mild cases to tackling complications requiring hospitalization.



What are the complications of each illness?

Complications are generally rare but include skin infections, pneumonia, neurological issues for severe chickenpox and rheumatic fever following scarlet fever. Prompt treatment reduces complication risk.

How long do the illnesses typically last?

On average, scarlet fever symptoms persist for 1 week if properly treated. Uncomplicated chickenpox usually resolves in 5-10 days. Convalescence can take longer if complications develop.

How can I prevent the spread of these illnesses at home?

Isolation of active cases, proper hand hygiene, covering coughs/sneezes, disinfecting shared surfaces, and not sharing personal items help reduce transmission rates.

Can I get scarlet fever or chickenpox if I’ve already had them?

Generally, repeat episodes are very uncommon because the immune system confers long-term protection after initial infection or vaccination. Periodic local recurrences of chickenpox can rarely occur.

Are there any home remedies for scarlet fever or chickenpox?

Expert evaluation is vital for accurate diagnosis and aligned treatment of both illnesses. While symptom relief at home does help recovery, do not attempt to self-treat without consulting a licensed healthcare provider.


In summary, scarlet fever and chickenpox showcase how two distinct pathogens produce similar rash presentations, particularly early on. Recognizing differentiating features like sore throat and tongue changes or blister lesions and distribution enables proper diagnosis. This allows timely directed therapy – antibiotics specifically for scarlet fever and symptomatic relief for viral chickenpox. With both diseases, maintaining vigilance for suggestive symptoms and urgently seeking medical attention provides optimal outcomes. Our expanding medical knowledge promises continued enhancements in managing these common contagious childhood ailments.


  • Scarlet fever is caused by Streptococcus bacteria, while chickenpox is from Varicella-Zoster Virus.
  • The rashes differ in appearance, progression and distribution.
  • Additional symptoms help further distinguish the two illnesses.
  • Health providers facilitate accurate diagnosis and treatment.
  • Good hygiene and vaccination aid prevention.
5/5 - (1 vote)

Related articles


Cold Plasma System

The world's first handheld cold plasma device

Learn More

Made in USA