Guttate Psoriasis

Guttate psoriasis is a skin condition that often appears suddenly, usually following an infection, and creates small, teardrop-shaped red patches across the body. While most people recover fully, understanding this condition can help you manage symptoms and know when to seek medical care.

Table of contents

• What is guttate psoriasis?
• Who gets guttate psoriasis?
• Symptoms
• Causes and triggers
• Diagnosis
• Is it contagious?
• Treatment and management
• Outlook and prognosis
• Related conditions

L40.4

What is guttate psoriasis?

Guttate psoriasis is a type of psoriasis (a skin condition caused by an overactive immune system) that appears as small, drop-like spots on the skin. The word “guttate” comes from the Latin word “gutta,” meaning “drop,” which describes the teardrop shape of the patches^[1].

This form of psoriasis is different from the more common plaque psoriasis. While plaque psoriasis shows up as large, thick, scaly patches that form plaques, guttate psoriasis creates many small red or pink patches that usually have healthy skin around them. The patches in guttate psoriasis are typically between 2 and 10 millimeters wide and don’t always have as much scale as plaque psoriasis^[1][4].

Guttate psoriasis often develops suddenly, without warning, and usually appears after a bacterial infection^[1]. Most people who develop guttate psoriasis will recover completely. However, about one-third of people who have guttate psoriasis may later develop chronic plaque psoriasis^[1].

Who gets guttate psoriasis?

Guttate psoriasis is most common in children and young adults, especially those under 30 years old. It accounts for about 2% to 8% of all psoriasis cases^[1][2]. Both boys and girls, men and women, are affected equally, and it can occur in people of all races^[3].

For many people, guttate psoriasis is the first sign of psoriasis they experience. However, it can also appear in people who already have other types of psoriasis^[5].

People who have a family history of psoriasis, especially if parents have chronic psoriasis, are more likely to develop psoriasis themselves^[1]. Those with weakened immune systems also have a higher risk. This includes people with HIV/AIDS, autoimmune disorders (conditions where the body’s defense system attacks its own tissues) like rheumatoid arthritis, or those receiving chemotherapy for cancer^[1][7].

Symptoms

The main symptom of guttate psoriasis is the sudden appearance of many small spots on the skin. These spots typically develop over just a few days^[5].

The spots have specific characteristics:

• They are round or teardrop-shaped
• On lighter skin, they appear pink or red; on darker skin, they may look purple, brown, or grayish^[4]
• They usually measure between 2 and 10 millimeters in width^[1]
• They may be covered with a fine, silvery scale that can peel or flake off^[7]
• They most commonly appear on the trunk (chest, back, and stomach), arms, and legs^[1][2]
• They can also develop on the face, ears, scalp, and neck^[2]

Itching is another common symptom. The patches of skin are usually irritated and itchy^[1][8].

In people with darker skin tones, guttate psoriasis can be challenging to diagnose because the spots may not appear red or scaly in the typical way^[2].

The course of guttate psoriasis typically follows a pattern: new spots continue to develop during the first month; the spots remain stable during the second month; and symptoms begin to improve during the third month^[13]. In most cases, an outbreak lasts two to three weeks^[4].

Causes and triggers

The exact cause of psoriasis is not fully understood, but doctors believe that both genes and the immune system are involved^[7][8].

Guttate psoriasis is caused by an overactive immune system that speeds up skin cell growth. Normally, skin cells grow and shed in about a month. With psoriasis, this process happens in just three or four days. Instead of shedding properly, the skin cells pile up on the surface, creating the patches seen in guttate psoriasis^[2].

There are two main factors associated with guttate psoriasis:

Genetics: Psoriasis is strongly connected to certain genes. Having family members with chronic psoriasis, especially parents, makes it more likely that a person will develop psoriasis^[1].

Bacterial infections: The most important trigger for guttate psoriasis is infection with Group A Streptococcus bacteria, which commonly causes strep throat and related illnesses. Guttate psoriasis typically develops one to three weeks after a streptococcal infection of the throat or, less commonly, around the anus^[1][3][5].

Other triggers that can cause guttate psoriasis to develop or worsen include:

• Viral infections, including flu, sinus infections, or upper respiratory infections^[2][8]
• Tonsillitis (inflammation of the tonsils)^[2]
• Injury to the skin, including cuts, burns, and insect bites^[8]
• Certain medicines, such as those used to treat malaria and certain heart conditions^[8]
• Stress^[2][8]
• Sunburn^[8]
• Excessive alcohol consumption^[8]

Diagnosis

Your doctor can usually diagnose guttate psoriasis by examining the affected areas of your skin. The distinctive appearance of the small, drop-like spots helps make the diagnosis^[1][7].

When making a diagnosis, your doctor will consider several factors:

• The appearance of the skin and the characteristic small, round, scaly spots^[2]
• The location of the spots on your body^[2]
• Whether you have itching^[2]
• Whether you recently had a sore throat or upper respiratory infection^[7]

To confirm the diagnosis, your doctor may order several tests:

Skin biopsy: A small sample of skin may be removed and examined under a microscope. This test can confirm the diagnosis of guttate psoriasis and rule out other skin conditions^[1][2].

Throat swab culture: This test looks for bacteria like those that cause strep throat, especially Group A Streptococcus. People with guttate psoriasis commonly test positive for this bacteria^[1][7].

Blood tests: Your doctor may order blood testing to look for immune system markers that show a current or recent bacterial infection^[1][7].

Guttate psoriasis may sometimes be confused with other conditions, such as pityriasis rosea and lichen planus, which is why proper diagnosis is important^[2].

Is it contagious?

Guttate psoriasis itself is not contagious and cannot be spread to other people^[1][7]. However, the bacterial infections that can trigger guttate psoriasis, such as strep throat, can be transmitted to others^[4].

Treatment and management

Although there is no cure for psoriasis, there are many effective treatments available today to help control symptoms and reduce flare-ups^[2]. The goal of treatment is to reduce inflammation, remove scales, and relieve itching^[1].

Treatment choices depend on how severe the psoriasis is and how well it responds to previous treatments. Your doctor will usually start with mild treatments and move to stronger ones if necessary^[1].

Treating the underlying infection

If you have a recent bacterial infection, your doctor may prescribe antibiotics to treat it^[7][8].

Topical treatments

Mild cases of guttate psoriasis are usually treated at home with creams and ointments applied directly to the skin^[7].

Corticosteroid creams or ointments (steroid creams) are commonly used to treat mild to moderate psoriasis. These medications reduce inflammation, slow down skin cell production, and reduce itching. They range in strength from mild to very strong and should only be used as recommended by your doctor. Overusing strong steroid creams can lead to skin thinning^[1][14].

Vitamin D creams are often used along with or instead of steroid creams. They work by slowing the production of skin cells and have an anti-inflammatory effect. Examples include calcipotriol, calcitriol, and tacalcitol^[14].

Moisturizers: Keeping the skin moist is an essential part of treatment. Thick creams, ointments, or petroleum jelly help seal in moisture and can reduce itching and scaling^[7][8].

Coal tar lotions: Coal tar can reduce scales, inflammation, and itchiness. It may be used to treat psoriasis affecting the limbs, trunk, or scalp if other treatments are not effective^[7][14].

Phototherapy

Phototherapy, or light therapy, is a medical procedure in which your skin is carefully exposed to ultraviolet light. This treatment has the most robust evidence for effectiveness in guttate psoriasis^[11]. It may be given alone or after you take a medicine that makes the skin more sensitive to light^[7][8].

Systemic treatments

For severe cases, doctors may prescribe medicines that work throughout the entire body to suppress the immune response. These include cyclosporine and methotrexate^[7][8].

A newer group of medicines called biologics can alter parts of the immune system and may be used for severe and difficult-to-treat cases^[2][7].

Self-care measures

Self-care is an important part of managing guttate psoriasis. Taking daily baths can help calm inflamed skin and remove scales. Use lukewarm water and avoid hot water, harsh soaps, and scrubbing, as these can worsen psoriasis^[7].

Other helpful self-care steps include avoiding triggers, not scratching the affected areas, and trimming your nails to prevent injury to your skin if you do scratch^[2].

Outlook and prognosis

The majority of people who have guttate psoriasis will recover completely^[1]. Guttate psoriasis may clear completely following treatment, especially with phototherapy^[7][8].

However, about one-third of people who develop guttate psoriasis will eventually develop chronic plaque psoriasis, which involves patches that form larger scaly areas called plaques^[1]. Some people may experience recurring episodes, especially if they continue to have streptococcal infections^[13].

Psoriasis is a lifelong condition, and symptoms may come and go throughout a person’s life^[2]. While there is no cure, treatments today are more effective than ever before, and research into new treatments continues^[2].

Regular exercise and a healthy diet are recommended because they can help prevent many health problems. People with psoriasis have a slightly higher risk of developing diabetes and cardiovascular disease than the general population^[20].

Related conditions

One in three people with psoriasis may also develop psoriatic arthritis, which causes tenderness, pain, and swelling in the joints and connective tissue, as well as stiffness^[2][20].

Treating psoriasis can help improve symptoms and may lower the risk of developing related conditions such as psoriatic arthritis, heart disease, obesity, diabetes, and depression^[2].