Guttate psoriasis

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

Psoriasis is a common disorder. The exact cause isn't known. But doctors think genes and the immune system are involved. Certain things can trigger an attack of symptoms.

With guttate psoriasis, in addition to strep throat, the following may trigger an attack:

• 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 people who have a weakened immune system. This may include people who have:

• HIV/AIDS
• Autoimmune disorders, including rheumatoid arthritis
• Chemotherapy for cancer

Symptoms may 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

Your health care provider will look at your skin. Diagnosis is usually based on what the spots look like.

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

Tests to confirm the diagnosis may include:

• Skin biopsy
• Throat culture
• Blood tests for recent exposure to strep bacteria

If you are recently infected, your provider may give you antibiotics.

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

• Cortisone or other anti-itch and anti-inflammatory creams
• 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 severe guttate psoriasis may receive medicines to suppress the body's immune response. These include cyclosporine and methotrexate. A newer group of medicines called biologics that alter parts of the immune system may also be used.

Your provider 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.

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

Call your provider if you have symptoms of guttate psoriasis.

Psoriasis - guttate; Group A streptococcus - guttate psoriasis; Strep throat - guttate psoriasis

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James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Seborrheic dermatitis, psoriasis, recalcitrant palmoplantar eruptions, pustular dermatitis, and erythroderma. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 10.

Lebwohl MG, van de Kerkhof P. Psoriasis. In: Lebwohl MG, Heymann WR, Coulson IH, Murrell DF, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 210.

Updated by: Ramin Fathi, MD, FAAD, Director, Phoenix Surgical Dermatology Group, Phoenix, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.