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Psoriasis is an inflammatory skin condition that causes raised, scaly, and red patches on the skin. It’s estimated that up to 5% of people have psoriasis (Mehlis, 2020). But, there are multiple types of psoriasis. One of those types is guttate psoriasis, a relatively uncommon form that can develop suddenly and is usually triggered by an infection. Here’s what you need to know about this uncommon type of psoriasis.
What is guttate psoriasis?
The medical definition of guttate means “resembling drops.” And that’s what the shape the inflamed patches on the skin take in guttate psoriasis. The papules are less than half of an inch in size and typically appear on the trunk or torso, arms, or legs, and may also occur on the scalp, feet, hands, or nails (Ko, 2010). A thin, scale-like film may cover the lesions. This differs from the more common chronic plaque psoriasis in which spots are thick and can itch and bleed (Rendon, 2019).
Guttate psoriasis is more common in children and young adults under 30 with a history of streptococcus (more commonly known as strep) infections (Mehlis, 2020). Some people only get a single flare-up, while others may have a flare after periods with no symptoms or skin concerns. Some people with several bouts of guttate psoriasis can develop chronic psoriasis (Maruani, 2019).
Stress rash: causes and treatments
What causes guttate psoriasis?
Several causes and risk factors may contribute to developing guttate psoriasis.
It is well established that there is a link between streptococcal upper respiratory tract infections and guttate psoriasis. Eruption of guttate lesions may appear 1-3 weeks after an infection (Maruani, 2019).
Experts don’t fully understand the relationship between strep infection and guttate psoriasis. One theory is that the immune system, triggered by specific proteins on the strep bacteria, also attacks certain proteins in skin cells (Maruani, 2019).
Genetic predisposition and environment
Some people have an increased risk for this type of psoriasis because of their genes. Up to half of the people with this condition have a family history of guttate psoriasis. Environmental factors, like stress, may also contribute to its development (Maruani, 2019).
There have been cases of guttate psoriasis in people undergoing treatment with medications known as tumor necrosis factor (TNF)- alpha inhibitors. These drugs are often used to treat rheumatoid arthritis. Again, the reason why that’s the case isn’t fully understood yet (Rendon, 2019).
How is it diagnosed?
A physical examination by a doctor, specifically a dermatologist, is needed for a diagnosis. Studying skin samples (via skin biopsy) may be used to confirm or support that diagnosis. (Maruani, 2019).
The skin lesions seen with guttate psoriasis are similar to rashes seen in other diseases. So a healthcare provider may have to rule out pityriasis rosacea, ringworm, secondary syphilis, small plaque parapsoriasis, and nummular dermatitis to confirm the diagnosis. It can also be classified as mild, moderate, and severe based on the presence of skin lesions (Saleh, 2021).
Psoriasis: what is it, causes, symptoms, treatment
How do you treat it?
There is no cure for guttate psoriasis, but it can be treated and managed in multiple ways.
The first line of therapy for mild guttate psoriasis is topical steroid treatment. Ointments are the most effective, but steroids can also be found as gels, lotions, creams, and sprays (Saleh, 2021).
Other treatments, which can also overlap with general psoriasis treatments, applied directly to the skin include vitamin D analogs, retinoids, and salicylic acid (Rendon, 2019; Blakely 2016). Some of these treatments are over the counter, whereas others require a prescription (Saleh, 2021). Corticosteroids and vitamin D analogs are usually applied to lesions once or twice daily for around two weeks (Rathi, 2012).
Guttate psoriasis can also be treated using light therapy or phototherapy. The preferred light therapy uses an ultraviolet light (UV) method called narrowband UVB. UV light is the type of light the sun emits, and with the treatment comes the risk of burns and signs of early skin aging (Patrizi, 2017).
Phototherapy is considered a type of medical treatment, but not everyone has access to it. Those without access to that treatment may experience some relief with 5-10 minutes of noontime sun exposure (Mehlis, 2020). However, evidence is lacking on the impact of that type of self-exposure to UV light for symptom management.
Tonsillectomies may be recommended for children with repeated streptococcal infections. If those infections also trigger guttate psoriasis, then a tonsillectomy may be effective in reducing guttate psoriasis. However, it is not a stand-alone or widespread treatment recommendation because the data at hand is limited. It also won’t benefit people whose guttate psoriasis can’t be traced directly to repeated tonsillitis (Rendon, 2019).
Plaque psoriasis: what is it, symptoms, treatment
Although a streptococcal bacterial infection like strep throat may trigger guttate psoriasis, the value of using antibiotics to treat it is unclear due to the lack of scientific data. However, since streptococcal infections are the leading cause, if you believe you have strep, it’s best to see a healthcare provider to confirm a diagnosis and receive appropriate treatment (Dupire, 2019).
If guttate psoriasis spreads to the scalp and causes dandruff, shampoos with salicylic acid or clobetasol propionate may be beneficial (Blakely, 2016).
Coal tar has been used for decades to treat psoriasis. It’s commonly found in lotions and can be applied directly to psoriatic patches (Blakely, 2016).
Can guttate psoriasis be prevented?
Unfortunately, you cannot prevent guttate psoriasis, but exposure to some disease triggers can be avoided. Common triggers of psoriasis flare-ups include (National Psoriasis Foundation, 2021; Xhaja, 2014):
- Some medications (like beta-blockers)
- Skin disturbances
Living with guttate psoriasis
Proper medical care is essential for diagnosing guttate psoriasis and for treatment and management of the condition. The course of the disease is unpredictable. In some cases, it may resolve after a single appearance, but for others, it’s a lifelong condition that can spontaneously remit or progress into a chronic plaque psoriasis diagnosis (Ko, 2010).
There are some over-the-counter remedies you can use at home to manage symptoms, like lotions and shampoos (Saleh, 2021). But medical attention may be necessary for more severe occurrences. Talk to your healthcare provider if you think you may have guttate psoriasis. They can work with you to come up with a treatment plan that best serves your medical needs.
- Blakely, K., & Gooderham, M. (2016). Management of scalp psoriasis: current perspectives. Psoriasis (Auckland, N.Z.), 6, 33–40. doi: 10.2147/PTT.S85330. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29387592/
- Dupire, G., Droitcourt, C., Hughes, C., & Le Cleach, L. (2019). Antistreptococcal interventions for guttate and chronic plaque psoriasis. The Cochrane Database of Systematic Reviews, 3(3), CD011571. doi: 10.1002/14651858.CD011571.pub2. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30835819/
- Ko, H. C., Jwa, S. W., Song, M., Kim, M. B., & Kwon, K. S. (2010). Clinical course of psoriasis: long-term follow-up study. The Journal of Dermatology, 37(10), 894–899. doi: 10.1111/j.1346-8138.2010.00871.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20860740/
- Maruani, A., Samimi, M., Stembridge, N., Abdel Hay, R., Tavernier, E., Hughes, C., & Le Cleach, L. (2019). Non-antistreptococcal interventions for acute guttate psoriasis or an acute guttate flare of chronic psoriasis. The Cochrane Database of Systematic Reviews, 4(4), CD011541. doi: 10.1002/14651858.CD011541.pub2. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30958563/
- Mehlis, S. (2020). Guttate Psoriasis. In K. C. Duffin & A. O. Ofori (Eds.). Retrieved September 14, 2021 from https://www.uptodate.com/contents/guttate-psoriasis
- National Psoriasis Foundation. (2021). Guttate psoriasis: Causes, symptoms and treatments. Retrieved September 16, 2021, from https://www.psoriasis.org/guttate/
- Patrizi, A., Raone, B., & Ravaioli, G. M. (2017). Safety and Efficacy of Phototherapy in the Management of Eczema. Advances in Experimental Medicine and Biology, 996, 319–331. doi: 10.1007/978-3-319-56017-5_27. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29124712/
- Rendon, A., & Schäkel, K. (2019). Psoriasis Pathogenesis and Treatment. International Journal of Molecular Sciences, 20(6), 1475. doi: 10.3390/ijms20061475. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30909615/
- Rathi, S. K., & D’Souza, P. (2012). Rational and ethical use of topical corticosteroids based on safety and efficacy. Indian Journal of Dermatology. doi: 10.4103/0019-5154.97655. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22837556/
- Saleh, D., & Tanner, L. S. (2021). Guttate Psoriasis. [Updated Aug 3, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482498/
- Xhaja, A., Shkodrani, E., Frangaj, S., Kuneshka, L., & Vasili, E. (2014). An epidemiological study on trigger factors and quality of life in psoriatic patients. Materia Socio-Medica, 26(3), 168–171. doi: 10.5455/msm.2014.26.168-171. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25126009/
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.