GUTTATE PSORIASIS: An Overview of the Second Most Common Form of Psoriasis

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Guttate Psoriasis

Suffering from a streptococcal (strep) infection of the throat is bad enough – with the throat pain and fever that goes along with the infection – but what if you or one of your children also end up with an itchy rash of tiny red spots all over your body? Guttate psoriasis could be the culprit.

WHAT IS GUTTATE PSORIASIS?

Guttate psoriasis is a form of psoriasis that is characterized by multiple, small teardrop-shaped, salmon colored plaques or spots that tend to affect most of the body. It gets its name from the Latin word guttate which means “drop.” Guttate psoriasis looks like a shower of reddish-pink, scaly tear drops that have fallen down on your body. The plaques are usually concentrated around your trunk, upper arms and thighs. The face, ears and scalp may also be affected. It is the second most common form of psoriasis.

WHAT ARE THE SYMPTOMS OF GUTTATE PSORIASIS?

The guttate psoriasis rash comes on very quickly, it is usually triggered 7-10 days after the onset of a strep throat infection. The spots are fairly small (less than ½-inch in size) and round-oval in shape. You will typically see an even distribution of the rash over your body, especially on the trunk and limbs, where the spots can number into the hundreds. If guttate psoriasis occurs on the face, ears or scalp, the spots are usually fainter and more sparing.

Guttate psoriasis won’t appear on your palms, the soles of your feet or on your fingernails like other forms of psoriasis. Flare-ups of guttate psoriasis occur more often in the winter, when the air is dry. The spots associated with guttate psoriasis are typically not as thick and scaly as plaque psoriasis, but they can develop a thicker, silvery scale in the later stages.

WHAT ARE THE STAGES OF GUTTATE PSORIASIS?

There are three stages of guttate psoriasis:

  • Mild – only a few pink spots cover about 3% of your skin.
  • Moderate – darker plaques cover 4-10% of your skin.
  • Severe – Many plaques cover more than 10% of your body, possibly covering most of it.
    • The plaques have more scale.

Guttate psoriasis may be staged differently, however, depending on how it affects your quality of life. For example, if it is on your face or scalp – covering less than 3% of your skin – it could be considered moderate to severe because it affects your appearance and livelihood.

WHO GETS GUTTATE PSORIASIS?

Guttate psoriasis is most common in children and young adults, but it can affect people of all ages. It can occur without the onset of an infection, however, it is most often present after a diagnosis of strep throat. While some people who are affected by guttate psoriasis go on to develop ordinary or plaque psoriasis, about one third do not have a family history and will not develop any other types of psoriasis in adulthood.

WHAT ARE THE TRIGGERS OF GUTTATE PSORIASIS?

An outbreak of guttate psoriasis is mainly triggered by the bacterial infection of streptococcus, more commonly known as strep throat. Guttate psoriasis, like all forms of psoriasis, is an autoimmune disorder. Your body treats your own cells like invaders and attacks them.

So, when you or your child gets a strep infection it sets off an immune system reaction that causes the spots to flare up. Guttate psoriasis may only occur once, or you may get several flare-ups. In many cases, guttate psoriasis is genetic. If someone in your family has it, your chances of being affected by it go up.

Besides strep throat, other triggers of guttate psoriasis include:

  • Upper respiratory infections
  • Tonsillitis
  • Stress
  • Cuts, burns or bites on your skin
  • Some drugs such as antimalarials and beta-blockers
  • Dysfunction of the nervous or endocrine system
  • Hormonal disorders
  • Genetic predisposition
  • Environmental risks
  • Sunburn
  • Alcohol abuse

Guttate psoriasis may become more severe in people with an extremely weakened immune system. This may include those who have HIV/AIDS, autoimmune disorders such as rheumatoid arthritis or are undergoing chemotherapy treatment for cancer.

Guttate psoriasis often comes on quite quickly, even if you don’t believe you are suffering from a strep infection. Strep throat often presents itself with no symptoms, so if you do have a flare-up of guttate psoriasis it is always wise to test for an underlying infection.

HOW IS GUTTATE PSORIASIS DIAGNOSED?

At the first sight of any of the signs and symptoms of guttate psoriasis, it is important to see a doctor to confirm the diagnosis. Your doctor, typically a dermatologist, can diagnose guttate psoriasis by performing a physical examination of your skin.

Other things your doctor may do to determine the condition are to confirm recent bouts of strep throat or other infections (possibly ordering a throat swab) and performing a skin biopsy and/or blood test to rule out other possible conditions.

Similar conditions to guttate psoriasis include:

  • Seborrheic dermatitis
  • Lichen planus
  • Ringworm of the body
  • Pityriasis rosea

HOW DO YOU TREAT AND MANAGE GUTTATE PSORIASIS?

If you suffer an outbreak of guttate psoriasis, it is normally very manageable. If left untreated, however, complications can occur. Potential complications may include pain, secondary skin infections and itching.

Treatments for guttate psoriasis include:

  • Topical Medications – over-the-counter or prescription options to help itchy, flaky, dry skin and control swelling. However, it may become tedious to apply to the numerous spots on the skin.
    • Cortisone cream
    • Medicated dandruff shampoo
    • Lotions with coal tar
    • Moisturizers
    • Prescription medicines containing vitamin D or vitamin A (retinoids)
  • Oral Medications – if your case of guttate psoriasis is more serious, your doctor may prescribe medicine to take by mouth.
    • Immune suppressants such as corticosteroids, cyclosporine or methotrexate
    • Medications that alter parts of the immune system called biologicals
  • Phototherapy – also known as light therapy, your doctor will shine ultra-violet onto your skin to clear guttate psoriasis.
    • UVB – the use of ultraviolet light B
    • PUVA – the use of the light-sensitizing drug psoralen with ultraviolet light A

WHAT IS THE OUTCOME FOR GUTTATE PSORIASIS?

An acute flare-up of guttate psoriasis usually spontaneously resolves itself within a few weeks or months. Following treatment, it may clear completely – especially after phototherapy. Sometimes, however, guttate psoriasis may become a chronic condition or worsen to the more common plaque-type psoriasis.

Age may be a factor in whether it will resolve completely or become a chronic condition. Children who are affected by the condition may not see any further flare-ups. Unfortunately, if you are afflicted with guttate psoriasis as an adult, the condition is more likely to become chronic or flare up with subsequent strep or viral infections.

Some people affected by guttate psoriasis may also develop a type of arthritis called psoriatic arthritis.

WHAT ARE LIFESTYLE CHANGES THAT CAN HELP GUTTATE PSORIASIS?

Although you may be genetically predisposed to guttate psoriasis or other types of psoriasis, improving your overall health will greatly reduce the risk of another flare up. Lingering infections, stress, physical injury, excessive weight and alcohol use are all factors that can make the condition worse or cause it to become chronic. 

Taking the step to improve your health is one of the best lifestyle changes you can make to help reduce the complications from guttate psoriasis. Exercising, relaxation techniques and limiting alcohol intake are some examples of positive lifestyle changes. Also, the food you eat – or don’t eat – may also play a role in helping to reduce the flare ups of guttate psoriasis. Ingredients that cause chronic inflammation by increasing the inflammatory receptors in your body include spicy foods, nightshade vegetables, dairy, sugar, sodium and gluten. By limiting your intake of these food ingredients, you can help reduce the effects of guttate psoriasis.

If you enjoyed reading this article on guttate psoriasis, you may also like to read our article on Putting Eczema Herpeticum Into Perspective.