Guttate psoriasis is a skin condition that usually develops suddenly without any warning signs, although it typically follows an infection such as strep throat. The hallmark sign of this disease is the appearance of red scaly patches on the skin. This condition is more common in young adults.

Continue reading to learn more about guttate psoriasis, why it occurs, and the treatment options available for managing this condition.

What is Guttate Psoriasis?

Guttate psoriasis is an autoimmune disorder, meaning the immune system fails to recognize the body's healthy cells as its own and treats them like invaders and attacks and destroys them. This rare form of psoriasis is characterized by the appearance of tiny red or pink, scaly, and teardrop-shaped spots on the skin.

Most patients develop this condition in childhood or early adulthood. Oftentimes, patients will have only one episode. However, it is possible to have several flare-ups over time.

What are the symptoms of Guttate Psoriasis?

The hallmark sign of guttate psoriasis is the appearance of red spots on the skin that are notably smaller than the ones seen in patients with plaque psoriasis.

It is possible to be diagnosed with both guttate psoriasis and plaque psoriasis at once, with typical signs such as scaly, red spots on the arms, legs, chest, and upper body that can sometimes spread to the face, scalp, neck, and ears. However, unlike other forms of psoriasis, guttate psoriasis usually does not affect the skin of the palms, the soles of the feet, or the nails.

What are the stages of Guttate Psoriasis?

There are three main stages of Guttate Psoriasis, including:

Mild: Lesions and spots may cover only about 3% of the skin.
Moderate: Lesions spread to cover between 3% to 10% of the skin.
Severe: Lesions have spread to cover more than 10% of the skin, even sometimes covering the entire body.

The stage can be determined based on the extent to which the symptoms interfere with someone’s daily life. For example, psoriasis on the face or scalp affects only 2% to 3% of the total skin surface. However, it is still classified as severe because it affects their emotional well-being.

Psoriasis on the hands covers only 2% of the total skin area. However, it can affect the livelihood of the patient if he or she works with their hands. In this case, the condition would be classified as moderate or severe.

What are the causes of Guttate Psoriasis?

An outbreak of this condition is usually triggered following streptococcal bacterial infection (strep throat). This infection, which causes a sore throat, can set off an immune system reaction, which leads to the appearance of red spots on the skin.

In some cases, the condition is genetic, and you may have a higher chance of developing Guttate psoriasis if a parent or sibling has this condition.

Some other triggers and causes of this condition include:

Infections such as upper respiratory infections, sinus infections, and the flu
Tonsillitis
Stress
Certain medicines, such as beta-blockers and antimalarial drugs
Cuts, burns, bites, and other injuries to the skin

Diagnosis of Guttate Psoriasis

Your doctor will ask about your medical history and family history, including the medications you are using and whether anyone in your family has or had similar symptoms. Your healthcare provider will also examine your skin to diagnose or rule out guttate psoriasis.

If your physician needs more information, he might ask you to undergo additional tests such as blood tests and throat culture to check for streptococcal infection. Blood tests for the diagnosis of guttate psoriasis are aimed at assessing the levels of immune system markers that suggest the possibility of a current or recent infection.

If your symptoms are severe, your doctor might perform a skin biopsy and send the sample to a laboratory for further testing and evaluation.

Treatment for Guttate Psoriasis

An episode of guttate psoriasis typically lasts for about 2 to 3 weeks before resolving. There is no cure for this condition, but there are treatment and management options aimed at relieving the symptoms of acute episodes and preventing flare-ups in the future.

Some treatments commonly recommended for people with guttate psoriasis include the following:

Medications for guttate psoriasis

There are several prescription and over-the-counter medicines for reducing the symptoms of this condition, such as swelling, dryness, itching, and flakiness of the skin.

For mild psoriasis, doctors will recommend treatments to help control symptoms, including:

Creams, lotions, and ointments containing corticosteroids to relieve swelling and itching
Prescription medicine containing vitamin D, such as calcipotriene
Topical retinoids, such as tazarotene
Topical calcineurin inhibitors
Salicylic acid

If your symptoms are more serious, your physician might prescribe you a combination of therapies, which can include oral corticosteroids, biologic injections such as Tremfya (guselkumab) or Taltz (ixekizumab), and immunosuppressants such as apremilast (Otezla), methotrexate, and deucravacitinib (Sotyktu). However, these treatments are not well-studied for guttate psoriasis.

Phototherapy

For moderate to severe guttate psoriasis, phototherapy is a common treatment. Also referred to as light therapy, this method involves exposing the affected skin to ultraviolet B (UVB) and ultraviolet A (UVA) light emitted by a phototherapy device.

Your doctor may also recommend a combination of medication and phototherapy if you have severe guttate psoriasis.

Prevention of Guttate Psoriasis

Unfortunately, it is difficult to predict who can develop guttate psoriasis. This makes it difficult to identify productive measures to prevent this condition from developing.

However, if you have a medical history or family history of guttate psoriasis, there are steps you can take to lower your chances of developing this condition.

The preventive measures for guttate psoriasis usually involve identifying and avoiding the triggers. Some common triggers that can make you vulnerable to developing guttate psoriasis include:

Bacterial and viral infections, especially upper respiratory tract infections such as strep throat
Skin injuries such as cuts, scrapes, burns, sunburns
Uncontrolled diabetes
Insect bites or insect stings
Excessive alcohol intake
Certain medications, such as lithium and antimalarial drugs
Mental stress

Avoiding these triggers can reduce the frequency and intensity of exacerbations of guttate psoriasis.

What is the prognosis of Guttate Psoriasis?

Most people with guttate psoriasis, including children, do not develop any serious complications, and symptoms resolve in a few weeks.

About 40% of patients with guttate psoriasis will eventually develop chronic plaque psoriasis, which is a lifelong condition with no cure for this condition.

Guttate Psoriasis: Frequently Asked Questions

Is guttate psoriasis a lifelong disease?

Guttate psoriasis is not a lifelong condition. It usually develops suddenly and goes away within a few weeks. Some patients may have recurring symptoms, but the skin lesions usually clear up on their own without medical intervention.

About 30% of cases of guttate psoriasis progress to develop chronic plaque psoriasis, which is a lifelong illness.

What is psoriatic arthritis?

Guttate psoriasis can sometimes involve the joints, leading to the development of psoriatic arthritis. This condition is a form of arthritis that affects some people diagnosed with psoriasis. It causes joint pain and stiffness throughout the body.

What is the difference between plaque psoriasis and guttate psoriasis?

Guttate psoriasis usually affects children, teenagers, and young adults under 30 years of age, while chronic plaque psoriasis can appear at any age, usually with two or more peaks. It is more common in young adults between 20 and 30 years of age and elderly people between 50 and 60 years of age.

Guttate psoriasis is usually triggered by a bacterial infection such as strep throat, while the triggers for plaque psoriasis vary widely among different cases.

Guttate psoriasis is less common than plaque psoriasis. However, guttate psoriasis can sometimes develop into plaque psoriasis.

What causes guttate psoriasis to flare up?

Exposure to risk factors such as upper respiratory infections, excessive alcohol intake, and mental stress can cause guttate psoriasis to flare up.

How do you stop a guttate psoriasis flare-up?

You can lower your chances of a guttate psoriasis flare-up by avoiding exposure to known risk factors such as certain medications, lowering your stress levels, avoiding infections, and protecting the skin from injury.

Can guttate psoriasis be triggered by stress?

Yes, guttate psoriasis can be triggered by stress. Hence, taking steps to relieve mental stress is highly recommended for preventing future episodes.

Is guttate psoriasis a contagious condition?

Although this condition usually occurs after a contagious bacterial infection such as strep throat, guttate psoriasis is not a contagious condition and does not spread to others.

Can alcohol intake make guttate psoriasis worse?

Yes, consuming too much alcohol is one of the known triggers for recurring flare-ups of guttate psoriasis.

Can an upper respiratory infection like streptococcal infection trigger guttate psoriasis?

Yes, upper respiratory infections such as streptococcal infection are the most common cause of this condition.

When is guttate psoriasis likely to flare up?

You are more likely to have a flare-up of symptoms during the winter months when the air is cold and dry. Symptoms typically clear up as the weather warms up.

References: