Guttate Psoriasis

Guttate psoriasis is a type of psoriasis that looks like small, salmon-pink drops on the skin. The word guttate is derived from the Latin word gutta, meaning drop. Usually there is a fine scale on the drop-like lesion that is much finer than the scales in plaque psoriasis, which is the most common type of psoriasis.

Guttate Psoriasis Photo

Guttate psoriasis. Red drop-like lesions are found on the skin.

Image courtesy of Hon Pak, MD.

Guttate psoriasis is not contagious and usually occurs on the trunk, arms, or legs. However, it may cover a large portion of the body.

The trigger of the disease is usually a streptococcal (bacterial) infection. The eruption of the skin lesions usually happens about two to three weeks after a person has strep throat. The outbreak can go away and not recur. Outbreaks may also go away and come back, particularly if the person is a strep carrier (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. This type of psoriasis can also be chronic and can be triggered by infections other than those from streptococcal bacteria. For example, the chicken pox or colds can trigger the 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. Boys and girls are equally affected.


Guttate Psoriasis Causes

An outbreak of guttate psoriasis may be an immune reaction that is triggered by a previous streptococcal infection or some other type of infection. The immune system makes white blood cells that protect the body from infection. In psoriasis, the T cells (a type of white blood cell) abnormally trigger inflammation in the skin and the production of excess skin cells.

Factors that may trigger guttate psoriasis include the following:

  • Streptococcal infection: As many as 80% of people with guttate psoriasis have a streptococcal infection, usually in the form of tonsillopharyngitis, 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 chicken pox, rubella, and roseola, may also trigger outbreaks in children.

Guttate psoriasis may also be inherited. Those with a family history of psoriasis have an increased chance of having the disease. Some people carry genes that make them more likely to develop psoriasis.

Guttate Psoriasis Symptoms

  • Small, salmon-pink (or red) drops usually appear suddenly on the skin two to three weeks after a streptococcal infection, such as strep throat or tonsillitis.
  • The drop-like lesions usually itch.
  • 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 not occur.

When to Seek Medical Care

You may want to see your doctor or health care practitioner if you have a sudden eruption of small red drop-like lesions of 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 itching. This type of psoriasis usually "runs its course" and goes away without treatment in a few weeks.


Exams and Tests for Guttate Psoriasis

Guttate psoriasis is typically diagnosed after the doctor or health care practitioner performs a physical exam of the skin. A dermatologist generally can tell if it is psoriasis just by looking at the skin. Skin biopsies are seldom necessary to confirm diagnosis.

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

Home Remedies for Guttate Psoriasis

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.

Over-the-counter topical steroids may help to reduce inflammation and itching.

Medical Treatment for Guttate Psoriasis

Usually, guttate 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.

  • Antibiotics: If you have a history of psoriasis, the doctor will most likely take a throat culture when you have a sore throat. If the culture results are positive (meaning that you have 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. It slows the production of excess skin cells made in psoriasis, and has been shown to decrease the number of skin mast cells that cause inflammation in psoriasis.

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

More resistant cases may benefit from PUVA therapy, which combines an oral psoralen drug with exposure to ultraviolet A light. Psoralen drugs make the skin and eyes more sensitive to the sun. The drug is taken a few hours before the light therapy. Precautions need to be taken to prevent exposure to the sun for 24 hours after treatment because the skin is extra sensitive to the sun and can blister. For more information on psoralen drugs, see Understanding Psoriasis Medications.

People using PUVA therapy may experience a number of adverse effects, such as nausea and vomiting. These effects are sometimes remedied by taking psoralen pills after a meal. The sensitivity to the sun persists up to 24 hours after someone takes the drug. The person on PUVA therapy should wear special protective sunglasses and should avoid sun exposure during this treatment period.


Medications for Guttate Psoriasis

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. Always tell your doctor what drugs you are currently taking because of the possibility of drug reactions.

Erythromycin (EES, E-Mycin, Ery-Tab) -- Reduces inflammation and is used to treat bacterial infections. The usual dosing is one to three tablets per day by mouth for about seven to 14 days. People with allergies to erythromycin or who have liver problems should not take this drug. Discontinue use if nausea, vomiting, fatigue, intestinal cramping, or fever occurs.

Penicillin VK (Veetids, Beepen-VK) -- Is used to treat bacterial infections. The usual dosing is one or two tablets per day by mouth for about 10 to 14 days. People with allergies to penicillin should not take this drug. Caution is taken with the dosing of this drug in those who have reduced kidney function.

Rifampin (Rifadin, Rimactane) -- Recommended for resistant cases of streptococcal infection. If the doctor thinks it is possible that the infection will last a long time and you may become a chronic carrier of the bacteria, he or she may prescribe this drug. Rifampin is usually given in addition to either erythromycin or penicillin. The drug is taken by mouth over the course of five days.

You should be aware of possible allergic reactions to any antibiotic used, especially penicillin. Stop taking the drug if an allergic reaction is suspected. Patients who are sensitive to penicillin generally do well on erythromycin. Cephalosporin is an antibiotic that can also be used for streptococcal infections, but some cross-sensitivity with penicillins has been documented.

Surgery for Guttate Psoriasis

Although unproven by large controlled studies, a tonsillectomy (procedure to remove the tonsils) for patients with chronic guttate psoriasis due to streptococcal infections in the tonsils may be helpful.

Preventing Guttate Psoriasis

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 is clear, so:

  • Early detection and treatment of such infections may prevent an acute flare-up of the skin disease. Some doctors recommend antibiotic therapy for sore throat in people who are susceptible to guttate psoriasis outbreaks.


Outlook for Guttate Psoriasis

  • Although guttate psoriasis usually clears up within a few weeks, it may also be the first step to chronic plaque psoriasis.
  • 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.


Media file 1: Guttate psoriasis. Red droplike lesions are found on the skin.

Image courtesy of Hon Pak, MD.

Guttate Psoriasis Photo

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Media file 2: Guttate psoriasis. Image courtesy of Hon Pak, MD.

Guttate Psoriasis Photo

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Media file 3: A close-up view of guttate psoriasis. Notice the salmon-pink (red) droplike lesions. Fine scales can be seen on the lesions. These scales are much finer than those associated with plaque psoriasis.

Image courtesy of Hon Pak, MD.

Guttate Psoriasis Photo

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Media file 4: Plaque psoriasis. Notice the scales are not as fine as those associated with guttate psoriasis. Image courtesy of Hon Pak, MD.

Plaque Psoriasis Photo Contrast

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WebMD Medical Reference from eMedicineHealth Reviewed by Debra Jaliman, MD on October 12, 2015




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