Psoriasis - guttate

Definition

Guttate psoriasis is a skin condition in which small, red, teardrop-shaped spots appear on the arms, legs, and middle of the body. Guttate means "drop" in Latin.

See also: Psoriasis

Alternative Names

Guttate psoriasis

Causes, incidence, and risk factors

Guttate psoriasis is a relatively uncommon form of psoriasis. It is usually seen in patients younger than 30. The condition often develops very suddenly, usually after an infection, most notably strep throat. Guttate psoriasis is not contagious.

Psoriasis seems to be an inherited disorder. That means it is passed down through families. Doctors think it probably occurs when the body's immune system mistakes healthy cells for dangerous substances. See: Inflammatory response

In addition to strep throat, the following may trigger an attack of guttate psoriasis:

• 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

In general, psoriasis may be severe in persons who have a weakened immune system. This may include persons who have:

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

Symptoms

Symptoms include itching and spots on the skin, called skin lesions, which are pinkish-red and look like teardrops. The spots may be covered with silver, flaky skin called scales.

The spots usually occur on the arms, legs, and middle of the body (the trunk), but may appear in other body areas.

Signs and tests

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

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

Tests to confirm the diagnosis include:

• Skin biopsy
• Throat culture

Treatment

The goal of treatment is to control your symptoms and prevent secondary infections.

If you have an infection, your doctor may give you antibiotics.

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

• Cortisone (anti-itch) cream
• Dandruff shampoos (over-the-counter or prescription)
• Lotions that contain coal tar
• Moisturizers
• Prescription medicines containing vitamin D or vitamin A (retinoids)

Persons with very severe guttate psoriasis may receive medicines to suppress the body's immune response. These medicines include corticosteroids, cyclosporine, and methotrexate.

Sunlight may help your symptoms go away. Be careful not to get sunburn. Some people may choose to have phototherapy. Phototherapy is a medical procedure in which your skin is carefully exposed to ultraviolet light. Phototherapy may be given alone or after you take a drug that makes the skin sensitive to light.

Expectations (prognosis)

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

Complications

• Pain
• Secondary skin infections
• Severe itching

Calling your health care provider

Call your health care provider if you have symptoms of guttate psoriasis.

References

van de Kerkhof PCM, Schalkwijk J. Psoriasis. In: Bolognia JL, Jorizzo JL, Rapini RP, eds.: Dermatology. 2nd ed. Philadelphia, Pa: Mosby Elsevier; 2008: chap 9.