Psoriasis - guttate

  • Definition
    • Guttate psoriasis is a skin condition in which small, red, scaly teardrop-shaped spots with a silvery scale appear on the arms, legs, and middle of the body. Guttate means "drop" in Latin.

  • Causes
    • Guttate psoriasis is a type of psoriasis. It is usually seen in persons younger than 30. The condition often develops suddenly. It usually appears after an infection, most notably strep throat caused by group A strep. Guttate psoriasis is not contagious. This means it cannot spread to other people.

      Psoriasis seems to be passed down through families. Doctors think it probably occurs when the body's immune system mistakes healthy cells for harmful substances.

      In addition to strep throat, the following may trigger an attack of guttate psoriasis:

      • Bacteria or viral infections, including upper respiratory infections
      • Injury to the skin, including cuts, burns, and insect bites
      • Some medicines, including those used to treat malaria and certain heart conditions
      • Stress
      • Sunburn
      • Too much alcohol

      Psoriasis may be severe in persons who have a weakened immune system. This may include persons who have:

  • Symptoms
    • Symptoms include:

      • Itching
      • Spots on the skin that are pinkish-red and look like teardrops
      • Spots may be covered with silver, flaky skin called scales
      • Spots usually occur on the arms, legs, and middle of the body (the trunk), but may appear in other body areas
  • Exams and Tests
    • Your doctor will look at your skin. Diagnosis is usually based on what the spots look like.

      Often, a person with this type of psoriasis has recently had a sore throat or upper respiratory infection.

      Tests to confirm the diagnosis may include:

      • Skin biopsy
      • Throat culture
  • Treatment
    • Goal of treatment is to control your symptoms and prevent secondary infections.

      If you have a current or recent infection, your doctor may give you antibiotics.

      Mild cases of guttate psoriasis are usually treated at home. Your doctor may recommend any of the following:

      • Cortisone (anti-itch and anti-inflammatory) cream
      • Dandruff shampoos (over-the-counter or prescription)
      • Lotions that contain coal tar
      • Moisturizers
      • Prescription medicines that have vitamin D to apply to the skin (topically) or that have vitamin A (retinoids) to take by mouth (orally)

      People with very severe guttate psoriasis may receive medicines to suppress the body's immune response. These medicines include cyclosporine and methotrexate. A newer group of medicines called biologics that alter parts of the immune system may also be used.

      Your doctor may suggest phototherapy. This is a medical procedure in which your skin is carefully exposed to ultraviolet light. Phototherapy may be given alone or after you take a medicine that makes the skin sensitive to light.

  • Outlook (Prognosis)
    • Guttate psoriasis may clear completely following treatment. Sometimes, it may become a chronic (lifelong) condition, or worsen to the more common plaque-type psoriasis.

  • Possible Complications
    • Untreated, this condition may result in:

      • Pain
      • Secondary skin infections
      • Severe itching
  • When to Contact a Medical Professional
    • Call your health care provider if you have symptoms of guttate psoriasis.

  • References
    • Lebwohl MG, van de Kerkhof CM. Psoriasis. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 203.