Guttate Psoriasis

Overview

What is guttate psoriasis?

Guttate psoriasis is a skin disease that often appears without warning and usually follows an infection like strep throat. It’s most common in young adults but can also happen in adults. The hallmark symptom of this condition is breaking out in small, red scaly patches.

Who does guttate psoriasis affect?

The majority of guttate psoriasis cases are seen in children. However, young adults, especially those younger than 30 years old, can also develop it. Guttate psoriasis accounts for about 2% of all cases of psoriasis.

Is guttate psoriasis the same as chronic psoriasis?

Guttate psoriasis is related to chronic psoriasis, but they aren’t the same condition. The majority of people who have guttate psoriasis will recover completely. However, it’s estimated that about one-third of the people who develop guttate psoriasis ultimately develop chronic psoriasis, which involves patches that form larger scaly areas called “plaques.” Psoriasis is an inflammatory disease, which means your body’s immune system overreacts for an unknown reason and causes the symptoms of psoriasis.

Symptoms and Causes

What are the symptoms of guttate psoriasis?

Symptoms of guttate psoriasis include:

  • Round or teardrop-shaped pink or red patches of skin. These patches are usually between 2 millimeters (mm) and 10 mm in width. These patches are how the disease got its name, which comes from the Latin word for “drop” (as in a teardrop). These patches most often appear on your torso, legs and arms, but can also develop on other parts of your body. Scales of dry skin that peel or flake off the red patches also may appear.
  • Itching. The patches of skin are usually irritated and itchy.

Does guttate psoriasis happen in stages?

Guttate psoriasis doesn’t progress in stages and tends to appear without warning, usually after a bacterial infection. While guttate psoriasis doesn’t have stages, it can progress to chronic plaque psoriasis, but that’s a separate condition.

What causes guttate psoriasis?

Two main factors have been associated with guttate psoriasis:

  • Genetics. Psoriasis is strongly connected to at least two genes but may be connected to others. Having family members — especially parents — with chronic psoriasis makes it more likely a person will develop chronic psoriasis as well.
  • Bacterial infections. Guttate psoriasis is usually connected to infections caused by Group A Streptococcus, which commonly causes strep throat and related illnesses.

People with HIV, autoimmune disorders (like rheumatoid arthritis) or whose immune systems are suppressed by chemotherapy also have a higher risk of developing guttate psoriasis.

Is guttate psoriasis contagious?

While it’s strongly connected to bacterial infections that are contagious, like strep throat, guttate psoriasis isn’t contagious and can’t be spread to others.

Diagnosis and Tests

How is guttate psoriasis diagnosed?

Your healthcare provider can usually diagnose guttate psoriasis by examining the affected areas of your skin. They may also order the following tests to confirm their diagnosis:

  • Skin biopsy: A sample of skin may be taken for testing to confirm the diagnosis of guttate psoriasis.
  • 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.
  • Blood tests: Your healthcare provider may order blood testing to look for immune system markers that show a current or recent bacterial infection. These tests are commonly called “titers.”

Management and Treatment

How is guttate psoriasis treated?

Treatments for guttate psoriasis depend on the severity of the case. For milder cases, the following are usually recommended:

  • Creams that treat itching and inflammation, especially those containing cortisone or other corticosteroids (which reduce inflammation).
  • Creams and lotions that have coal tar in them.
  • Medications containing vitamin D (to be applied on your skin) or that contain vitamin A (taken by mouth).
  • Over-the-counter or prescription-strength dandruff shampoo (for guttate psoriasis on your scalp).

Severe cases may be treated using the following:

  • Immunosuppressant medications: Like chronic psoriasis, guttate psoriasis also responds to medications that reduce your body’s immune response.
  • Biologic medications: These medications target specific parts of your immune system and block them. This can reduce psoriasis symptoms.
  • Phototherapy: Ultraviolet light (UV), either on its own or combined with a medication taken by mouth or applied to your skin, can treat guttate psoriasis. Laser therapy may also be used when guttate psoriasis becomes chronic plaque psoriasis.

Prevention

Can guttate psoriasis be prevented?

Unfortunately, there isn’t a way to know who will develop guttate psoriasis, which means there also isn’t a way to prevent it.

However, people who have a history of guttate psoriasis, especially those who develop chronic plaque psoriasis, can experience follow-up “attacks” of the condition. These are commonly connected to the following:

  • Bacterial or viral infections, especially respiratory infections like strep throat.
  • Burns and sunburns.
  • Cuts, scrapes and other skin injuries.
  • Insect bites and stings.
  • Certain medications (especially lithium and medications that treat malaria and certain heart problems).
  • Drinking too much alcohol.
  • Stress.

Outlook / Prognosis

What’s my long-term outlook if I have guttate psoriasis?

Most cases of guttate psoriasis — especially in children — will go away on their own. Some people may experience recurring instances of this condition, but these also may go away on their own without becoming chronic plaque psoriasis.

Guttate psoriasis that becomes chronic plaque psoriasis is a lifelong condition. While there isn’t a cure, there are many treatment options that can reduce the severity of symptoms and the frequency of flare-ups.

Living With

Is guttate psoriasis chronic?

Guttate psoriasis isn’t a chronic condition and usually goes away on its own after a few weeks. In some people, it can recur (come back), but this can also go away on its own.

In about one-third of cases, though, guttate psoriasis can become chronic plaque psoriasis. This is a separate, lifelong illness.

What’s the difference between guttate psoriasis and plaque psoriasis?

Here are some of the key differences between guttate psoriasis and chronic plaque psoriasis:

Guttate psoriasisChronic plaque psoriasis
Age of most people affectedChildren, teenagers and young adults, especially under 30.Appears at any age, usually with two peaks. These usually happen between 20-30 and 50-60 years of age.
Likely triggering eventBacterial infection such as strep throat.Triggers are widely varied from person to person.
AppearanceSmall red/pink patches, less than 10 mm wide. May have scales. Each patch is usually distinct and has healthy skin around it.Large red patches, often scaly. These tend to form large plaques, which are made up of several patches that are close together.
LocationUsually on the torso, as well as arms and legs. Can also appear elsewhere.Plaques are most common on elbows, knees, scalp and lower back. Can also appear elsewhere.
DurationUsually lasts a few weeks. About one-third of cases become chronic plaque psoriasis.Lifelong. May flare up because of stress or other factors.

Can guttate psoriasis cause joint pain?

Guttate psoriasis doesn’t cause joint pain, which is called psoriatic arthritis. Guttate psoriasis that progresses and becomes chronic plaque psoriasis can cause this, but only after it becomes the chronic form of the disease.

Does alcohol make guttate psoriasis worse?

Consuming too much alcohol is a known trigger for recurring episodes of guttate psoriasis. Psoriasis, in general, is also linked to higher alcohol consumption, which means reducing alcohol intake may be a good idea (your healthcare provider can advise you further on this).

When should I contact my healthcare provider?

It’s a good idea to contact your healthcare provider for any skin condition that involves this kind of reaction, especially if the affected skin appears scaly. It’s also important not to try treating it yourself using over-the-counter products unless your healthcare provider says it’s OK to do so.

A note from Cleveland Clinic

Guttate psoriasis is a condition that usually affects children. In most cases, it’s a temporary issue that will go away on its own. However, about one-third of people who have it will eventually develop chronic psoriasis. Fortunately, guttate psoriasis isn’t dangerous. If your child develops an unfamiliar rash — especially a scaly rash — you should talk to their pediatrician before treating it yourself.

Last reviewed by a Cleveland Clinic medical professional on 04/25/2022.

References

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