By Gary M. White, MD
Guttate psoriasis (GP) is a variant of psoriasis that appears as a diffuse eruption of small, red, scaly papules. It commonly is triggered by Strep throat. Guttate means "rain drop".
The sudden development of disseminated 0.5 - 2.0 cm. red, scaly papules or small plaques is characteristic. A streptococcal infection is a very common precipitant. One should inquire about a preceding sore throat, measure the ASO and take culture of the nose and throat. Perianal cellulitis has precipitated guttate psoriasis in children. This type of psoriasis is the most common type in children. If often remits spontaneously.
Secondary syphilis should be considered. Usually, this involves the palms and soles. Pityriasis rosea can look similar in the early stages. The presence of a herald patch helps here.
Any streptococcal infection should be treated. Medium to high potency topical steroid ointments are helpful for limited areas. For widespread involvement, nbUVB phototherapy as often as 5/week may be employed. Repeated sun exposure is helpful. If the disease eventuates into more typical plaque-type psoriasis, conventional antipsoriatic therapies may be used (see psoriasis).
Patients should be told they may have another flare of guttate psoriasis if they get the same trigger, e.g. a strep sore throat. In that case, they should seek medical attention right away for treatment, e.g. an oral antibiotic.
They should also be told that they have a higher risk of developing classic plaque type psoriasis in the future compared to the standard population. One small study showed that the risk of developing chronic psoriasis within 10 years of a single episode of acute guttate psoriasis is about 1 in 3.
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