What is Guttate Psoriasis?
Guttate psoriasis is a non-contagious and a rare form of psoriasis, which appears as small, salmon-pink colored drops on the surface of the skin. “Gutta” is a Latin word, which means drop and the word guttate is taken from this word. In many patients there is also a fine scale present on the drop-like lesion of guttate psoriasis. This scale is finer than the scales seen in plaque psoriasis. Guttate psoriasis is commonly seen on the arms, trunk or legs and in some cases can cover a large area of the body.
Streptococcal bacterial infection is the common trigger of guttate psoriasis. Patient starts to develop skin lesions of guttate psoriasis in about two to three weeks after suffering from a throat infection. It resolves after sometime after which patient may or may not have a recurrence. Outbreaks of guttate psoriasis come and go, especially if the patient is a strep carrier.
In some people, the sudden development of the typical skin lesions will be the first psoriasis outbreak; whereas, patients suffering from chronic plaque psoriasis may suddenly develop an episode of guttate psoriasis, which can be present for a long time and gets triggered by infections caused by other than streptococcal bacteria. Children and adults younger than 30 years are more commonly affected by Guttate psoriasis. This condition affects both girls and boys equally.
Causes of Guttate Psoriasis
Guttate psoriasis can occur as an immune reaction which is brought upon by an old bacterial or some other infection. Our immune system produces white blood cells which help in defending our body from infections. In psoriasis and its types, T cells, which are a type of WBCs, will abnormally trigger skin inflammation that results in production of excessive skin cells. Some of the factors which can trigger guttate psoriasis are:
Streptococcal Infection: Majority of the patients suffering from guttate psoriasis will have a streptococcal infection before the outbreak of guttate psoriasis. The exact method in which this infection triggers the guttate psoriasis lesions is not clear.
Viral Infections: Viral infections including rubella, chicken pox and roseola can also trigger outbreaks of guttate psoriasis in children.
Family History: Guttate psoriasis can also be inherited and individuals with a family history of psoriasis are at an increased risk for having guttate psoriasis.
Symptoms of Guttate Psoriasis
Patient develops drop like lesions on the skin, which are salmon-pink or red in color and small in size. Patient has sudden development of these drops about two to three weeks after a streptococcal infection (tonsillitis or strep throat). Patient also feels itching in these lesions. The outbreak of guttate psoriasis lesions often starts on the trunk, arms or legs. In some cases these lesions can also spread to the face, scalp or ears. The palms and soles are usually not affected. Patient also has changes in nails with development of ridges and pits on them which are a characteristic feature of chronic psoriasis.
Patient should seek immediate medical attention if he/she experiences sudden eruption of drop-like lesions that are small in size and red in color. In majority of the patients, the lesions of Guttate psoriasis will last for many weeks to some months. In some patients, these guttate psoriasis lesions can develop into chronic plaque psoriasis. Guttate psoriasis usually does not cause scarring.
Diagnosis of Guttate Psoriasis
Physical exam of the skin will confirm the diagnosis of guttate psoriasis. A dermatologist is able to diagnose guttate psoriasis just by looking at the skin. Very rarely biopsy of the skin is done for diagnosis. Blood tests can confirm a recent streptococcal infection in the patient, as there is increased levels of specific antibodies in many patients after a streptococcal infection.
Treatment for Guttate Psoriasis
The type of treatment depends on the severity of guttate psoriasis and patient’s preferences. In majority of the patients, guttate psoriasis resolves on its own in a few weeks without treatment.
Over-the-Counter Medications: Mild-to-moderate cases of Guttate psoriasis can be treated with OTC medications. It is important to keep the skin moisturized by applying a thick layer of moisturizer after a bath and to lock in the moisture, soften the skin and prevent further irritation. OTC topical steroids can be applied to reduce itching and inflammation. Itching in Guttate psoriasis gets relieved with medications and this form of psoriasis often runs its course and resolves without any treatment in some few weeks. Application of topical steroids is also effective, however, some patients can find this to be bothersome as the lesions can cover a large area of the body.
Moisturizers: Application of moisturizers will soften the skin and relieve itching and inflammation and is usually sufficient.
Antibiotics: A throat culture will be taken in patients with history of psoriasis and sore throat. Antibiotics, such as erythromycin, penicillin and rifampicin, are started if the result is positive to treat the infection.
Phototherapy: Phototherapy with the use of sunlight is very beneficial in clearing up guttate psoriasis. The ultraviolet rays of sunlight will help relieve the symptoms of psoriasis. Phototherapy also helps in decreasing the production of the excessive skin cells seen in psoriasis. Phototherapy also decreases the amount of mast cells which cause inflammation in guttate psoriasis. Artificial light consisting of narrowband ultraviolet B or broadband ultraviolet B light can also be used for treating guttate psoriasis.
PUVA Therapy: PUVA therapy can be done for more severe and resistant cases of guttate psoriasis. PUVA therapy is a combination of exposure to ultraviolet-A light and oral psoralen drug. Psoralen drug will the make the eyes and skin more sensitive to the sun. This drug is given to the patient a few hours before the commencement of light therapy. Patient needs to avoid sun exposure for 24 hours after PUVA therapy, as the sensitivity of the skin increases and is prone to blistering. PUVA therapy has many adverse effects, which include nausea and vomiting. To avoid such effects, the psoralen pills should be taken after a meal.
Surgery for Guttate Psoriasis: Surgery to remove the tonsils (tonsillectomy) is done in those patients who develop chronic guttate psoriasis as a result of streptococcal infections in the tonsils; although this is not yet proved by a large group of studies.
Prevention of Guttate Psoriasis
It is not possible to prevent Guttate psoriasis; however, further flare-ups or complications of Guttate psoriasis can be prevented by avoiding the triggers of an outbreak. Patients with psoriasis should avoid any injury or trauma to the skin. Patient should also avoid vigorous rubbing or scratching of the skin, as this may lead to development of new psoriatic lesions on those areas, which did not have psoriatic lesions before (Koebner phenomenon).
As Guttate psoriasis is associated with bacterial infections, it is also important to diagnose and start treatment early of such infections. This will prevent acute flare-ups of guttate psoriasis. Patients who are susceptible to guttate psoriasis and suffer from sore throat may be prescribed antibiotics.
Prognosis of Guttate Psoriasis
Guttate psoriasis often clears up in a few weeks; however, this condition could be the first step which leads to chronic plaque psoriasis. Guttate psoriasis, just like other types of psoriasis, tends to improve in the summer season and worsens in the winter season. After the guttate psoriasis has resolved, most of the patients do not experience a recurrence for long periods of time.
- Mayo Clinic. (2021). Guttate psoriasis. https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840