Guttate Psoriasis

Overview:

Guttate Psoriasis is a very specific subtype of psoriasis characterized by the abrupt onset of small drop-like plaques (‘guttate’) all over the body which often follows a sore throat or skin infection.  It is most often seen in children or young adults. 

Course

The presence of guttate psoriasis does suggest an underlying genetic predisposition to psoriasis although those cases induced by the presence of strep often have a more self limited quality.  Cases may come and go over weeks to months before spontaneously resolving.  A minority can go on to develop traditional chronic plaque psoriasis in the future.

Evaluation

The appearance and history of guttate psoriasis is often classic such that a biopsy is not required.  Pityriasis Rosea, Tinea Versicolor and secondary syphilis (depending on risk factors) are among the differential.  We will draw routine blood work including antibodies (ASO and anti-DNase B) looking for evidence of recent strep infection.  These are often positive even in patients with no recollection of infection.  A more expanded workup may be indicated in severe cases in which a systemic agent is being considered or in the event of diagnostic uncertainty.

Treatment

Given the strong correlation between strep and this subtype of psoriasis it is important to identify and treat any possible infection with antibiotics.  It is most commonly strep throat but skin infections with strep can also trigger an episode.  The rash is treated with generous application of moderate potency topical steroids.  Ultraviolet light therapy can also be beneficial.  Rarely, if the psoriasis fails to clear or to remain clear, consideration is given to systemic treatments such as Otezla, methotrexate, or biologics.

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