What is Guttate Psoriasis?
Psoriasis is a long-term skin condition that leads to well-identified, scaly, and reddened patches, and at times, pustules that don’t contain toxins or harmful organisms. There are various types of psoriasis, such as plaque psoriasis, guttate psoriasis, and forms of psoriasis that cause pustules. Frequently, psoriasis influences the joints, resulting in a condition known as psoriatic arthritis. Nail changes occur in about 10-80% of individuals who have psoriasis. The symptoms of psoriasis can vary widely, and it’s possible for someone to have multiple forms of the condition concurrently.
Guttate psoriasis is a specific type of psoriasis that typically appears following an infection caused by streptococcal bacteria, normally in the throat or in the area around the anus. This form of psoriasis is more prevalent in kids and teens compared to adults. Affected individuals will see several small ‘raindrop-like’ lesions on their skin, which generally respond positively to topical treatments (applied to the skin) and therapies using light.
What Causes Guttate Psoriasis?
The chances of developing a type of skin condition called guttate psoriasis can increase if you’ve recently had a streptococcal infection (which mainly affects the throat or rectum) or an upper respiratory infection (like a cold). This type of infection generally happens 1 to 3 weeks before skin spots, known as guttate lesions, start to appear.
Interestingly, these skin spots have also been observed after a person undergoes a certain treatment involving TNF-alpha, a protein involved in our body’s inflammatory response.
Risk Factors and Frequency for Guttate Psoriasis
About 2% of the world’s population, and as much as 4% of people in the United States and Canada, have psoriasis. The onset of this condition usually peaks in two different age ranges: 20 to 30 and 50 to 60 years old. One form of psoriasis, known as Guttate psoriasis, makes up less than 30% of all psoriasis cases. It affects both males and females equally, and is more commonly found in children and teenagers than in adults over 30.
- About 2% of people worldwide have psoriasis, but this number rises to 4% in the United States and Canada.
- The condition most frequently emerges between the ages of 20 and 30 or between 50 and 60.
- Guttate psoriasis represents less than 30% of all psoriasis cases.
- This form of the condition affects both genders equally.
- It is most prevalent in children and teenagers, as opposed to adults aged over 30.
Signs and Symptoms of Guttate Psoriasis
Guttate psoriasis is a skin condition that could be diagnosed by understanding a patient’s history and identifying any risk factors. It is common for this type of psoriasis to appear after a streptococcal infection, such as a throat infection or perianal streptococcus. Another potential trigger could be the recent use of TNF-alpha inhibitors, which are drugs sometimes used to treat certain autoimmune conditions.
In terms of physical symptoms, guttate psoriasis is characterized by many small, scattered bumps and plaques on the skin. Described as “drop-like,” these bumps are typically 2 to 6 mm in size. There is a known response called the Koebner phenomenon where new psoriasis patches can appear on areas of the skin that have been injured or affected by other conditions. This includes sunburn, wounds, or other skin issues such as chickenpox or Pityrosporum folliculitis. This reactive phenomenon is not unique to psoriasis and can occur in various other skin conditions too.
Pertaining to guttate psoriasis, there are a few other common characteristics:
- Redness of the skin (Erythema)
- Thickness of the skin patches (Acanthosis)
- Silver, scaly skin
- Auspitz sign: pinpoint bleeding when the surface of a psoriasis lesion is scraped off
All these characteristics provide clues about the changes happening under the skin, as reflected in skin biopsy results.
Testing for Guttate Psoriasis
Normally, doctors can diagnose guttate psoriasis based on your medical history and by examining your skin. In most cases, they don’t need to take a skin sample (biopsy) to confirm the diagnosis. However, these skin samples can show certain changes under the microscope, which can further support the diagnosis.
Similarly, if you’ve recently had a strep throat infection, it can be a clue that might guide the diagnosis toward guttate psoriasis. Doctors can find this out by conducting a blood test, which checks for certain substances, like antistreptolysin O, anti-DNase B, or streptozyme. If your body is producing high amounts of these substances, it means you’ve recently been infected with strep throat.
Treatment Options for Guttate Psoriasis
For mild psoriasis, a condition causing skin cells to build up and form scales and itchy and dry patches, the first line of defense is usually creams or ointments known as topical corticosteroids. These come in different forms including ointments, creams, lotions, gels, foams, sprays, and even shampoos. However, these treatments are not recommended when a person has bacterial, viral, or fungal skin infections, or very thin skin.
If corticosteroids don’t work or aren’t appropriate, next up for treating mild psoriasis could be a medication called anthralin, potentially alongside steroids. Other options include vitamin D analogs, retinoid creams, calcineurin inhibitors, which affect your immune system, and salicylic acid, an ingredient found in many skincare products.
For moderate to severe cases of psoriasis, light therapy, or phototherapy, is often the first line of treatment. This includes exposure to ultraviolet B (UVB) light or ultraviolet A (UVA) light after treatment with a medication called psoralen. This combination is commonly referred to as PUVA. The best type of UVB therapy can depend on the specific type of psoriasis you have; for example, broadband UVB may work better for guttate psoriasis, while narrowband UVB is better for plaque psoriasis. If you have localized psoriasis plaques, an option could be treatment with a type of laser called an excimer laser.
In the case of plaque psoriasis, which is characterized by patches of raised, reddish skin covered with silvery-white scale, certain types of targeted biologic treatments may be recommended. These types of treatments work by influencing the immune system’s response. However, these treatments are not often used for guttate psoriasis, which appears as small, dot-like lesions, as their use in this form of the disease has not been well-studied. Biologic therapy is therefore usually reserved for guttate psoriasis cases that have evolved into plaque type.
What else can Guttate Psoriasis be?
When trying to diagnose guttate psoriasis, doctors also consider several other conditions that might cause similar skin symptoms. These conditions include:
- Tinea corporis (a type of skin fungus)
- Secondary syphilis (a sexually transmitted infection)
- Nummular eczema (dry, round patches of skin)
- Pityriasis rosea (a rash that usually begins as a large spot on the chest, abdomen, or back)
Doctors can often tell the difference between these conditions and guttate psoriasis by looking at the patient’s medical history and conducting a physical examination. Additional tests like a skin scraping and blood tests can also help rule out other conditions.
What to expect with Guttate Psoriasis
About 40% of people who have guttate psoriasis, a type of psoriasis characterized by small, droplet-like spots on the skin, may eventually develop plaque psoriasis. Plaque psoriasis is a more common form of the disease that results in thick, red skin patches covered with silvery scales.
