Guttate Psoriasis

Picture of guttate psoriasis.

• Guttate psoriasis is a type of psoriasis that appears as small, salmon-pink bumps on the skin. The word guttate is derived from the Latin word gutta, meaning drop. Usually there are fine scales atop the small round to oval lesion.
• Treatment may incorporate antibiotics and phototherapy.

As in all types of psoriasis, guttate psoriasis occurs in those with an inherited genetic predisposition and is not a contagious skin condition. Although guttate psoriasis usually occurs on the trunk, arms, or legs, it not unusual for the condition to involve any areas of skin (scalp, face, or ears).

The trigger to the condition is often a streptococcal (bacterial) sore throat followed within two to three weeks by the skin eruption. Guttate psoriasis may resolve entirely or may evolve into typical chronic plaque psoriasis. The disease may recur if the person is a strep carrier (always carries streptococcal bacteria in his respiratory system).

The sudden appearance of an outbreak may be the first psoriasis outbreak for some people. Alternatively, a person who has had plaque psoriasis for a long time may suddenly have an episode of guttate psoriasis. The plaque variety of psoriasis can also be chronic and can be triggered by infections other than those from streptococcal bacteria. For example, the chickenpox or colds can trigger psoriasis.

Who Gets Guttate Psoriasis?

The guttate form of psoriasis is relatively uncommon. Fewer than 2% of those with psoriasis have the guttate type. Guttate psoriasis is more common in children and adults younger than 30 years of age. Boys and girls are equally affected by the medical condition.

An outbreak of guttate psoriasis is thought to be triggered by a previous streptococcal infection or some other type of infection. The precise mechanism whereby streptococcal infections induce psoriasis awaits more research.

Since psoriasis may be inherited, those with a family history of psoriasis have an increased chance of developing the guttate form of the disease. Some people carry genes that make them more likely to develop psoriasis. The precise manner in which these genes interact with molecules produced by streptococcal bacteria or other microorganisms resulting in guttate psoriasis is currently not fully understood.

• Streptococcal infection: As many as 80% of people with guttate psoriasis have a streptococcal infection, usually in the form of tonsillopharyngitis (strep throat), before the outbreak. Even though the connection between these infections and the outbreaks has been known for over 50 years, the exact mechanism by which the infection triggers the lesions is unknown.
• Viral infections, such as chickenpox, rubella, and roseola, may also trigger outbreaks in children.

• Small, salmon-pink (or red) papules (bumps) usually appear suddenly on the skin two to three weeks after a streptococcal throat infection, or tonsillitis.
• The drop-like lesions may causes symptoms such as itching.
• The outbreak usually starts on the trunk, arms, or legs and sometimes spreads to the face, ears, or scalp. The palms and the bottoms of the feet are usually not affected.
• Nail changes, such as pits and ridges, which are characteristic of chronic psoriasis, may be absent.

Guttate psoriasis is a medical condition that is typically diagnosed after a doctor or health care professional performs a physical exam of the skin. The dermatologist (skin doctor) generally can tell if it is psoriasis just by clinical judgment based on the appearance of the skin lesions.

Skin biopsies are occasionally necessary to confirm diagnosis of psoriatic lesions.

Blood tests to rule out other treatable diseases may be necessary. In young children, certain drug eruptions and occasionally viral rashes (examthems) can be confused with guttate psoriasis.

Findings from blood tests may confirm that the patient had a streptococcal infection recently. Increased levels of antibodies to the streptolysin-O are present in more than one-half of patients.

This type of psoriasis may be treated at home in most mild to moderate cases. Keeping the skin moist will prevent extra irritation. Thick moisturizers applied after a bath to keep in moisture and soften the skin are helpful.

If it is summertime or the patient is in a part of the country where there is plenty of sunlight, careful graded increases in sun exposure may be quite helpful in diminishing the eruption. One must take special care to avoid a sunburn because this can occasionally result in an exacerbation of the eruption.

Over-the-counter topical steroids like 1% hydrocortisone cream may help to reduce inflammation and itching.

People should see a doctor or health care professional if they develop a sudden eruption of small red drop-like lesions of guttate psoriasis. Dermatologists, doctors who specialize in the treatment of skin disease, are best equipped to diagnose and treat guttate psoriasis. This form of psoriasis is usually a mild inconvenience to most people. Most of the time, the lesions last several weeks to a few months. Other times, the guttate eruption can develop into chronic plaque psoriasis. Scarring is not a problem.

The doctor can prescribe treatments that help relieve the itching. This type of psoriasis usually "runs its course" and goes away without medical treatment in a few weeks.

Usually, this type of psoriasis goes away in a few weeks without treatment. Simple reassurance and moisturizers to soften the skin may be sufficient care. The choice of treatment depends on the severity of the outbreak and the individual's preferences. For example, applying topical steroids, although effective, could be bothersome because the outbreak occurs over a large portion of the body in most cases of guttate psoriasis.

• Antibiotics: If someone has a history of psoriasis, the doctor will most likely take a throat culture when that individual has a sore throat. If the culture results are positive (meaning that the individual has a streptococcal infection), then starting immediately on antibiotics for the infection is very helpful.
• Phototherapy: Sunlight can help clear up this type of psoriasis. The ultraviolet (UV) light in sunlight helps to reduce psoriasis symptoms in some people.

The doctor may prescribe a short course of artificial light therapy (phototherapy). Broadband ultraviolet B or narrowband ultraviolet B light may be used.

It is probably advisable to avoid the ultraviolet lights provided in tanning salons.

Doctors may use antibiotics when the guttate psoriasis is related to a streptococcal infection. They may choose an antibiotic that will act on a wide range of bacteria. People should always tell their doctor what drugs they are currently taking because of the possibility of drug reactions.

Be aware of possible allergic reactions to any antibiotic used, especially penicillin. Stop taking the drug if an allergic reaction is suspected. Occasionally, chronic guttate psoriasis resistant to light therapy and antibiotics may require treatment with systemic medications used to treat classical plaque-type psoriasis.

• Although guttate psoriasis usually clears up within a few weeks, it may also be the first step to chronic plaque psoriasis, especially if it lasts for longer than a year.
  • The acute guttate form progresses into the chronic plaque form in an estimated 33% of people.
  • In another study of 15 patients, the likelihood of an individual developing chronic psoriasis within 10 years of a single episode of acute guttate psoriasis was suggested to be about one in three. Although further studies with larger numbers of patients are needed to determine the risk more accurately.
• Like other forms of psoriasis, guttate psoriasis has the tendency to improve during the summer and worsen during the winter. Once the outbreak clears, many patients with acute guttate psoriasis usually have limited or no evidence of psoriasis for prolonged periods.

Although unproven by large controlled clinical trials, a tonsillectomy (procedure to remove the tonsils) for patients with chronic guttate psoriasis that is the result of streptococcal infections in the tonsils may be helpful.

Guttate psoriasis may not be preventable. However, complications or further flare-ups may be reduced by avoiding anything that triggers a psoriasis outbreak. For example, anyone with psoriasis should try to minimize all forms of skin trauma, such as scratching or vigorous rubbing, which may lead to new psoriatic lesions on previously unaffected areas. This is known as the Koebner phenomenon.

The association between streptococcal infections and guttate psoriasis cannot be overemphasized.

• Early detection and treatment of such infections may prevent an acute flare-up of the skin disease. Samples should be obtained and cultured in patients who are susceptible to psoriasis and have a sore throat.
• Some doctors advocate early antibiotic therapy of any sore throat in individuals who are susceptible.

The National Psoriasis Foundation is an excellent organization that provides support to patients with psoriasis.

American Academy of Dermatology