Guttate psoriasis is often made worse by a bacterial infection, typically Streptococcus (strep throat). The infection causes an immune response that targets skin cells, leading to inflammation and skin lesions about 2-3 weeks after the sore throat.
Common triggers of guttate psoriasis include:
- Bacterial infection
- Upper respiratory infection (such as COVID-19 infection)
- Emotional stress
- Cold, dry weather
- Skin injury
- Excessive sun exposure
- Obesity
- Smoking
- Excessive alcohol consumption
- Certain medications such as malaria drugs (such as chloroquine), lithium, antihypertensives (beta-blockers, ACE inhibitors), and interferons
- Hormonal changes during puberty or menopause
Triggers and severity of guttate psoriasis flare-ups vary from person to person. What worsens the condition in one person may not worsen it in someone else.
What are symptoms of guttate psoriasis?
Psoriasis is a chronic autoimmune condition that affects the skin, leading to the formation of plaques and scales.
Guttate psoriasis is a type of psoriasis characterized by small, scaly, salmon-colored bumps on the skin. It is called “guttate” because the skin lesions appear like small water drops on the skin (gutta means “drop” in Latin). The disease mainly affects children and young adults.
Skin lesions are mainly seen on the arms, torso, and legs, although they can also appear on the other sites such as the scalp, ears, and face. Guttate psoriasis scales are typically finer than the thick, silvery scales seen in plaque psoriasis, which is the more common type of psoriasis. Skin lesions are quite small, typically less than 10 mm in size.
How is guttate psoriasis treated?
Guttate psoriasis lesions typically go away on their own within weeks or months. Treatment can help limit the severity and progression of symptoms.
Treatment of guttate psoriasis varies depending on the underlying cause, severity of symptoms, and affected areas of the body. Treatment generally consists of:
- Corticosteroids: These provide relief from inflammation by calming the overactive immune system and reducing the excessive proliferation of skin cells.
- Antimicrobials: Because strep throat is often associated with guttate psoriasis, lab testing may be done to detect the presence of infection. Appropriate antibiotics are then prescribed.
- Phototherapy: This involves exposure to sunlight or a short course of either broadband ultraviolet B (UV-B) or narrow-band UV-B phototherapy. In more resistant cases, psoralen may be used along with UV-A radiation exposure.
Additional therapies include:
- Vitamin D analogs
- Tar-based products
- Topical retinoids
In some cases, guttate psoriasis may not respond to the above treatment methods. Such patients may have a high risk of chronic plaque psoriasis. Treatment of this type of chronic psoriasis is more extensive and may include systemic medications such as:
- Biologic agents
- Cyclosporine
- Acitretin
- Methotrexate
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