Consider referring a patient with scarlet fever for specialist evaluation if they have severe symptoms that cannot be managed in primary care, or if there is a suspected serious or life-threatening complication. Also refer if the patient is at high risk of developing complications based on clinical judgement. Children with persistent or worsening symptoms should have a low threshold for prompt referral to secondary care. Additionally, seek urgent specialist advice or hospital admission if there are signs of systemic illness, dehydration, breathing difficulty, or complications such as invasive Group A streptococcal infection.
For high-risk contacts or immunosuppressed patients, specialist advice may be needed regarding exclusion and antibiotic prophylaxis.