Guttate psoriasis is a type of psoriasis that appears as small, salmon-pink drops on the skin. The word guttate is derived from the Latin word gutta which means drop. There is a fine scale on the drop-like lesion which is much finer than the scales in plaque psoriasis, which is the most common type of psoriasis. Guttate psoriasis is not contagious and it occurs on the trunk, arms, or legs. But it may cover a large portion of the body.
The trigger of the disease is often a streptococcal infection. The eruption of the skin lesions commonly happens about 2-3 weeks after a person has strep throat. The outbreak may go away and not recur. Outbreaks can also go away and come back, particularly if the person is a strep carrier. The sudden appearance of an outbreak can be the first psoriasis outbreak for some people. Instead, a person who has had plaque psoriasis for a long time can suddenly have an episode of guttate psoriasis. This type of psoriasis can be chronic and can be triggered by infections other than those from streptococcal bacteria.
Who Gets Guttate Psoriasis?
The guttate psoriasis is uncommon. Fewer than 2% of those with psoriasis have the guttate type. Guttate psoriasis is commonly occur in children and adults younger than 30 years. Boys and girls are equally affected.
What’s Causing Guttate Psoriasis?
An outbreak of guttate psoriasis can be an immune reaction that is triggered by a previous streptococcal infection or other type of infection. The immune system will make white blood cells that protect the body from infection. In psoriasis, the T cells abnormally trigger inflammation in your skin and the production of excess skin cells.
What are the Factors that May Trigger Guttate Psoriasis?
- Streptococcal infection: 80% of people with guttate psoriasis have a streptococcal infection before the outbreak. However, the connection between these infections and the outbreaks is known for over 50 years, the exact mechanism by which the infection triggers the lesions is still unknown.
- Viral infections, such as chicken pox, rubella, and roseola, can also trigger outbreaks in children.
- Guttate psoriasis may be inherited. It is noted that those with a family history of psoriasis have an increased chance of having the disease. Some people carry genes that make them more likely to have psoriasis.
What are the Symptoms of Guttate Psoriasis?
- The drop-like lesions usually itch.
- Small, salmon-pink drops usually appear suddenly on your skin two to three weeks after a streptococcal infection, such as strep throat or tonsillitis.
- The outbreak often starts on the trunk, arms, or legs and sometimes spreads to the face, ears, or scalp. The palms and the bottoms of the feet are usually not affected.
- Nail changes, such as pits and ridges may not occur.
When to Worry?
You may want to see your doctor if you have a sudden eruption of small red drop-like lesions of guttate psoriasis. This form of psoriasis is often a mild inconvenience for most people. Most times, the lesions will last several weeks to a few months. Other times, the guttate eruption may develop into chronic plaque psoriasis. Scarring is not a problem.
The doctor will prescribe treatments which help relieve itching. This type of psoriasis “runs its course” and goes away without treatment in a few weeks.
Home Remedies for Guttate Psoriasis
This type of psoriasis can be treated at home in mild-to-moderate cases. Keeping your skin moist will prevent extra irritation. Thick moisturizers that applied after a bath to keep in moisture and soften the skin can be helpful. Over-the-counter topical steroids also may help to reduce inflammation and itching.
Medical Treatment for Guttate Psoriasis
Commonly, guttate psoriasis fades away in a few weeks without treatment. Simple moisturizers to soften your skin will be sufficient care. Basically, the choice of treatment depends on the severity of the outbreak and the individual’s preferences. For example, applying topical steroids could be bothersome because the outbreak occurs over a large portion of your body in most cases.
Phototherapy: Sunlight will help clear up the guttate psoriasis. The ultraviolet (UV) light in sunlight can reduce psoriasis symptoms in some people. It can slow the production of excess skin cells that made in psoriasis, and has been shown to decrease the number of skin mast cells that cause inflammation in psoriasis.
Antibiotics: If you have a history of psoriasis, your doctor will take a throat culture when you have a sore throat. If the culture results are positive, then starting immediately on antibiotics for the infection will be very helpful.
The doctor may prescribe a short course of artificial light therapy and broadband ultraviolet B or narrowband ultraviolet B light can be used.
More cases may benefit from PUVA therapy, which combines an oral psoralen drug with exposure to ultraviolet A light. Psoralen drugs will make your skin and eyes more sensitive to the sun. The drug is taken a few hours before the light therapy.
People using PUVA therapy experience many adverse effects, such as nausea and vomiting. These effects are often remedied by taking psoralen pills after a meal. The sensitivity to the sun persists up to 24 hours after someone takes the drug. The person on PUVA therapy should wear special protective sunglasses and should avoid sun exposure during this treatment period.
What are the Medications for Guttate Psoriasis?
Doctors often use antibiotics when the guttate psoriasis is related to a streptococcal infection. They may also choose an antibiotic that acts on a wide range of bacteria. Tell your doctor what drugs you are taking because of the possibility of drug reactions.
- Erythromycin (EES, E-Mycin, Ery-Tab) can reduce inflammation and is used to treat bacterial infections. The usual dosing is 1-3 tablets per day by mouth for about seven to 14 days. People with allergies to erythromycin or those who have liver problems should not take this drug. Discontinue use if nausea, vomiting, fatigue, intestinal cramping, or fever occurs.
- Penicillin VK (Veetids, Beepen-VK) is used to treat bacterial infections. The usual dosing is 1-2 tablets per day by mouth for about 10 to 14 days. People with allergies to penicillin should not take this drug. Caution is taken with the dosing of this drug in those who have reduced kidney function.
- Rifampin (Rifadin, Rimactane) is recommended for resistant cases of streptococcal infection. If the doctor thinks it is possible that the infection can last a long time and you may become a chronic carrier of the bacteria, he may prescribe this drug. Rifampin is often given in addition to either erythromycin or penicillin. The drug is taken by mouth over the course of five days.
You should be aware of possible allergic reactions to any antibiotic that used, especially penicillin. Stop taking the drug if an allergic reaction is suspected. Patients who are sensitive to penicillin generally do well on erythromycin. Cephalosporin is an antibiotic that can also be used for streptococcal infections, but some cross-sensitivity with penicillins has been documented.
What is the Surgery for Guttate Psoriasis?
Although unproven by large controlled studies, a tonsillectomy for patients with chronic guttate psoriasis due to streptococcal infections in the tonsils can be helpful.
How to Prevent Guttate Psoriasis?
Guttate psoriasis might not be preventable. However, complications may be reduced by avoiding anything that triggers a psoriasis outbreak. For example, anyone with psoriasis should try to minimize all forms of skin trauma, such as scratching which may lead to new psoriatic lesions on previously unaffected areas. This is known as the Koebner phenomenon.
Early treatment of such infections can prevent an acute flare-up of your skin disease. Some doctors may recommend antibiotic therapy for sore throat in people who are susceptible to guttate psoriasis outbreaks.