Guttate Psoriasis

What is guttate psoriasis?

Guttate psoriasis is the second most common type of psoriasis, with some studies showing that around 10-30% of people with psoriasis have the guttate variant.1–3 This type of psoriasis is most commonly diagnosed in children and young adults under the age of 30.4 It often starts suddenly and is frequently triggered by a bacterial infection such as strep throat or tonsillitis, skin injuries, stress, or certain medications. It can sometimes be followed by the development of plaque psoriasis later in life or it can manifest as an exacerbation of plaque psoriasis.5

 

Symptoms

Distinct, small (1 to 10 mm in diameter), droplet-shaped, red- or pink-coloured spots usually appear on the torso, arms and legs. They can also appear, infrequently, on the scalp, ears, and face. “Gutta” means “drop” in Latin, which is where this type of psoriasis got its name. A fine scale covers the spots, but they are usually thinner than in those associated with plaque psoriasis. There can also be associated pain or itchiness, just like in plaque psoriasis. 

 

Diagnosis

Guttate psoriasis is clinically diagnosed, meaning that your doctor will take a thorough medical history and do a full physical examination, including taking a close look at your skin. They may ask you questions about when or how you first noticed your lesions, what symptoms you have, and what parts of your body are affected. A skin biopsy, where a small sample of the lesion is sent to a pathologist to view under a microscope, is generally unnecessary for diagnosis.

 

Treatment

The treatment of guttate psoriasis overlaps greatly with that of plaque psoriasis, but one major difference is that, given the possibility that a flare of guttate psoriasis will go away on its own within weeks to months, patients wanting to avoid therapy can forego treatment and wait it out.7 However, since the length of flare is unpredictable, many patients will choose to move forward with treatment. In this case, phototherapy is considered the first-line choice. Other options, such as topical corticosteroids and vitamin D analogs, and oral medications, can be considered if there is no response to phototherapy.8 Because guttate psoriasis is strongly linked with the bacteria that causes strep throat and tonsillitis, keeping the recurrence of strep throat and tonsillitis under control has also been shown to be helpful in reducing the number of guttate psoriasis flares.9

 

References

  1. Valenzuela F, Silva P, Valdés MP, Papp K. Epidemiology and quality of life of patients with psoriasis in Chile. Actas Dermosifiliogr. 2011;102(10):810-816.
  2. Rigopoulos D, Gregoriou S, Katrinaki A, et al. Characteristics of psoriasis in Greece: an epidemiological study of a population in a sunny Mediterranean climate. Eur J Dermatol. 2010;20(2):189-195.
  3. Kundakci N, Türsen U, Babiker MOA, Gürgey E. The evaluation of the sociodemographic and clinical features of Turkish psoriasis patients. Int J Dermatol. 2002;41(4):220-224.
  4. Ferrándiz C, Pujol RM, García-Patos V, Bordas X, Smandía JA. Psoriasis of early and late onset: a clinical and epidemiologic study from Spain. J Am Acad Dermatol. 2002;46(6):867-873.
  5. Weller R, Hunter J, Savin J, Dahl M. Clinical Dermatology , 2008: Malden.
  6. Jindal R, Chauhan P, Sethi S. Dermoscopic characterization of guttate psoriasis, pityriasis rosea, and pityriasis lichenoides chronica in dark skin phototypes: An observational study. Dermatol Ther. 2021;34(1):e14631.
  7. Ko H-C, Hyun-Chang KO, Seung-Wook JWA, Song M, Moon-Bum KIM, Kwon K-S. Clinical course of guttate psoriasis: Long-term follow-up study. The Journal of Dermatology. 2010;37(10):894-899.
  8. Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. J Am Acad Dermatol. 2010;62(1):114-135.
  9. Owen CM, Chalmers R, O’Sullivan T, Griffiths CEM. Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database of Systematic Reviews. Published online 2000.
  10. Weller RB, Hunter HJA, Mann MW. Psoriasis. In: Clinical Dermatology. 5th ed. Chichester, West Sussex: John Wiley & Sons; 2015:52-67.
Written by:
Amy Du, University of Alberta, March 2021
Reviewed by:
Dr. David Adam, April 2021