Overview Of Guttate Psoriasis
Guttate psoriasis is characterized by the acute onset of small, 1-10 mm diameter, droplike, erythematous-to-salmon-pink papules, usually with a fine scale, as demonstrated in the images below.
See Psoriasis: Manifestations, Management Options, and Mimics, a Critical Images slideshow, to help recognize the major psoriasis subtypes and distinguish them from other skin lesions.
This variant of psoriasis primarily occurs on the trunk and the proximal extremities, but it may have a generalized distribution. Lesions usually spread centripetally and are monomorphic. New guttate psoriasis lesions continue to develop during the first month of disease they remain stable during the second month, and the remission begins during the third month. The word guttate is derived from the Latin word gutta, meaning drop.
Guttate psoriasis is more common in individuals younger than 30 years. An upper respiratory tract infection from group A beta-hemolytic streptococci often precedes the eruption by 2-3 weeks. Streptococcal perianal dermatitis, a superficial bacterial infection of the anus and perianal skin in children, has also been linked with the appearance of guttate psoriasis.
Although episodes may recur, especially those due to pharyngeal carriage of streptococci, isolated bouts have commonly been described. Generally, the disease is self-limiting, but a certain percentage of cases progress to chronic plaque psoriasis.
For more information, go to Psoriasis.
There Are Ways To Shorten Flare
Psoriasis is a big star on TV drug ads, but this autoimmune skin disease is something most people try to keep well hidden.
Psoriasis is among the most common skin conditions, affecting about 2% of the U.S. population, and while the condition doesnt affect everyone the same way, the approach to treatment and prevention is often similar, says Dr. Gideon Smith, an assistant professor of dermatology at Harvard-affiliated Massachusetts General Hospital.
Streptococcal Infection And Guttate Psoriasis
The association of guttate psoriasis with streptococcal infection has been recognized for more than 50 years. As many as 80% of patients with guttate psoriasis have clinical or laboratory evidence of streptococcal infection, usually in the form of tonsillopharyngitis.
The streptococcal serotypes in these patients are similar to those seen in the general population. Aside from group A streptococci, Lancefield groups C and G streptococci have also been related to guttate psoriasis. Although specific Lancefield groups have been associated with psoriasis, no association with any specific M serotype has been discovered.
A number of cases in children have also been triggered by streptococcal perianal cellulitis. Presumably, absorption of streptococcal by-products occurs across the mucosa, as with pharyngeal infections.
Unfortunately, although the association is definite, details regarding the exact mechanism by which streptococcal infection influences the formation of the psoriatic lesions are still largely theoretical.
Lotus et al demonstrated that guttate psoriasis patients expressing the HLA-Cw*0602 allele were twice as likely to have positive streptococcal throat cultures.
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What If Those Psoriasis Treatments Dont Work
If psoriasis doesnt improve, your healthcare provider may recommend these treatments:
- Light therapy: UV light at specific wavelengths can decrease skin inflammation and help slow skin cell production.
- PUVA: This treatment combines a medication called psoralen with exposure to a special form of UV light.
- Methotrexate: Providers sometimes recommend this medication for severe cases. It may cause liver disease. If you take it, your provider will monitor you with blood tests. You may need periodic liver biopsies to check your liver health.
- Retinoids: These vitamin A-related drugs can cause side effects, including birth defects.
- Cyclosporine: This medicine can help severe psoriasis. But it may cause high blood pressure and kidney damage.
- Immune therapies: Newer immune therapy medications work by blocking the bodys immune system so it cant jumpstart an autoimmune disease such as psoriasis.
Who Gets Guttate Psoriasis
Guttate psoriasis tends to affect children and young adults it is the second most common form of psoriasis in children after chronicplaque psoriasis. Both sexes and all races can develop guttate psoriasis. It is often the first presentation of psoriasis for an individual, but can also be seen in those with known chronic psoriasis.
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Are There Complications Of Psoriasis
In some people, psoriasis causes more than itchiness and red skin. It can lead to swollen joints and arthritis. If you have psoriasis, you may be at higher risk of:
- Use medicated shampoo for scales on your scalp.
Other steps you should take to stay as healthy as possible:
- Talk to your healthcare provider about lowering your risk for related conditions, such as heart disease, depression and diabetes.
- Lower your stress with meditation, exercise or seeing a mental health professional.
How Long Does Guttate Psoriasis Last
- Although guttate psoriasis usually clears up within a few weeks, it may also be the first step to chronic plaque psoriasis, especially if it lasts for longer than a year.
- The acute guttate form progresses into the chronic plaque form in an estimated 33% of people.
- In another study of 15 patients, the likelihood of an individual developing chronic psoriasis within 10 years of a single episode of acute guttate psoriasis was suggested to be about one in three. Although further studies with larger numbers of patients are needed to determine the risk more accurately.
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How Is Guttate Psoriasis Diagnosed
Dermatologists diagnose guttate psoriasis much as they do plaque psoriasis: mostly from the distinctive appearance of the rash, says Sugarman.
As part of the diagnosis, your doctor will ask whether youve had strep throat or another infection, and may do a skin biopsy and a throat culture to confirm the diagnosis, per UFHealth though this isnt often necessary. Your doctor may also ask whether youve been taking any new medications or supplements.
Most people get guttate psoriasis as children or young adults, according to the NPF. In older adults, it can often be a precursor to plaque psoriasis, and it often runs in families. But Shurlow says that in her family, only a cousin is also living with guttate psoriasis.
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Possible Causes For Psoriasis Remission
The goal of psoriasis treatment is to reduce the symptoms and hopefully end the flare. If treatments are successful, psoriasis may go into remission.
Even without treatment, psoriasis may disappear. Spontaneous remission, or remission that occurs without treatment, is also possible. In that case, its likely your immune system turned off its attack on your body. This allows the symptoms to fade.
This doesnt mean that you wont ever have another flare. Watch for symptoms of psoriasis so that you can begin treating them if they reappear.
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Pathophysiology Of Guttate Psoriasis
The exact pathophysiologic mechanism in guttate psoriasis is undetermined. Guttate psoriasis is believed to result from an immune reaction triggered by a previous streptococcal infection in a genetically susceptible host.
Studies indicate the importance of chromosome 6 in determining the resultant psoriatic phenotype. HLA-Cw*0602positive patients are more prone to develop the guttate form. Interactions of HLA-C with killer immunoglobulinlike receptors on natural killer cells or natural killer T cells can be deregulated by streptococcal infection. T lymphocytes and cytokines are believed to cause the characteristic inflammatory changes appreciated on histopathologic examination of lesions.
An autoimmune phenomenon has also been postulated to underlie guttate psoriasis because some streptococcal products and components have been found to cross-react with normal human epidermis. Electron microscopic studies of guttate psoriasis have shown that mast cell degranulation is an early and constant feature in the evolution of guttate psoriatic lesions. Furthermore, Langerhans cell migration appears to be impaired during an acute episode of guttate psoriasis.
Causes & Triggers Of Guttate Psoriasis
An outbreak is usually triggered by a bacterial infection — typically streptococcus . It sets off an immune system reaction that causes the spots on your skin.
In some cases, guttate psoriasis is genetic. If someone in your family has it, your chances of getting it go up.
Other triggers include:
- Cuts, burns, or bites on your skin
- Some drugs you take
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What Is The Treatment For Guttate Psoriasis
Usually, this type of psoriasis goes away in a few weeks without treatment. Simple reassurance and moisturizers to soften the skin may be sufficient care. The choice of treatment depends on the severity of the outbreak and the individual’s preferences. For example, applying topical steroids, although effective, could be bothersome because the outbreak occurs over a large portion of the body in most cases of guttate psoriasis.
- Antibiotics: If someone has a history of psoriasis, the doctor will most likely take a throat culture when that individual has a sore throat. If the culture results are positive , then starting immediately on antibiotics for the infection is very helpful.
The doctor may prescribe a short course of artificial light therapy . Broadband ultraviolet B or narrowband ultraviolet B light may be used.
It is probably advisable to avoid the ultraviolet lights provided in tanning salons.
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Is There A Timeline For Psoriasis Remission
Psoriasis is unpredictable, and psoriasis remission has no timeline. Sometimes, remission can be lengthy. You may not experience symptoms for months, even years. Remission can also be short-lived. You may start experiencing symptoms again within a few weeks of them disappearing.
One common psoriasis cycle involves having fewer symptoms and flares during summer months and more symptoms and flares during winter months. Thats likely because of how the two very different environments affect your skin. The weather in these two seasons can trigger psoriasis symptoms. Being aware of these triggers and others can help you reduce flare frequency and extend remission periods.
Although psoriasis may return on its own, something may prod its return. These things are called triggers. Being aware of the most common ones can help you reduce the likelihood of flares and possibly extend periods of remission.
What Are The Symptoms Of Guttate Psoriasis
Guttate psoriasis causes tiny bumps called papules. Guttate means resembling drops. So, the papules are drop-like bumps or raised spots. Guttate psoriasis does not occur in stagesthe papules usually appear suddenly on the arms, legs or torso. Less frequently, the bumps affect the face, scalp and ears. The bumps may itch and have the following appearance:
-
Raised and slightly thickened
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What Are The Stages Of Guttate Psoriasis
Guttate psoriasis has three stages: mild, moderate and severe. Mild guttate psoriasis is where there are only a few spots on your skin, covering about 3% of your body. Moderate guttate psoriasis is the next stage where there may be spots on 3% to 10% of your body. Severe guttate psoriasis is the highest stage and could see spots covering 10% of your skin.
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What Are Other Types Of Psoriasis
Plaque psoriasis is the most common type. About 80% to 90% of people with psoriasis have plaque psoriasis.
Other, less common types of psoriasis include:
- Inverse psoriasis appears in skin folds. It may look like thin pink plaques without scale.
- Guttate psoriasis may appear after a sore throat caused by a streptococcal infection. It looks like small, red, drop-shaped scaly spots in children and young adults.
- Pustular psoriasis has small, pus-filled bumps on top of the red patches or plaques.
- Sebopsoriasis typically appears on the face and scalp as red bumps and plaques with greasy yellow scale. This type is a cross between psoriasis and seborrheic dermatitis.
Epidemiology Of Guttate Psoriasis
The guttate form of psoriasis is relatively uncommon in the United States, occurring in less than 2% of the psoriatic population. International surveys on the guttate form of psoriasis among patients with psoriasis have found a wide range of prevalences, from 1.6-44%. A 2009 study has shown that the prevalence of psoriasis correlates with the distribution and mortality of streptococcal epidemics.
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Autoantibodies In Guttate Psoriasis
Immunoblotting has demonstrated intense antistreptococcal antibody activity in the sera of patients with guttate psoriasis. Immunoglobulin G antibodies against 3 different S pyogenes proteinsnamely, a 60-, a 70-, and a 14-kd antigenhave been identified. Indirect immunofluorescence studies of these antibodies showed that they react only with autologous skin in patients with guttate psoriasis and not with normal skin or lesional skin from patients who do not have psoriasis.
Autoantibodies in psoriatic sera may recognize certain structures in the transformed keratinocytes of affected psoriatic skin. These autoantibodies cross-react with streptococcal antigens. Cross-reaction has been demonstrated on immunofluorescent microscopy by using a monoclonal antibody to group A streptococci, which does not cross-react with antigens in normal human skin. These antigens were associated with class 1M protein and were mostly concentrated in the dermal papillae around the capillaries and inside the cells of the epidermal basal layer.
Generalised Pustular Psoriasis Or Von Zumbusch Psoriasis
This causes pustules that develop very quickly on a wide area of skin. The pus consists of white blood cells and is not a sign of infection.
The pustules may reappear every few days or weeks in cycles. During the start of these cycles, von Zumbusch psoriasis can cause fever, chills, weight loss and fatigue.
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What’s The Outlook Like After Having Guttate Psoriasis
- In nearly two thirds of people the spots clear up and never come back.
- Occasionally the spots turn into a more long-term type of psoriasis called plaque psoriasis. This can be treated with similar creams and light treatment.
- Once it’s cleared, sometimes a second outbreak of guttate psoriasis happens. This could happen if the streptococcus bug is lurking in your tonsils.
- Thankfully the guttate psoriasis never properly scars, although sometimes it can leave tiny pale marks where it used to be: these should fade with time though.
Narrowband Ultraviolet B Phototherapy
For adults with generalized plaque psoriasis, the recommended NB-UVB phototherapy starting dose should be based on the minimal erythema dose or it should be determined based on a fixed-dose or skin-phototype protocol.
For adults with generalized plaque psoriasis, a treatment phase of thrice-weekly dosing of NB-UVB phototherapy is recommended.
For adults with psoriasis, treatment with short-term psoralen plus ultraviolet A monotherapy is more effective than NB-UVB.
Owing to its increased safety, higher convenience, and lower cost, NB-UVB is preferred over PUVA monotherapy for psoriasis in adults, even though it is less effective.
In adults with generalized plaque psoriasis, NB-UVB is recommended over broadband ultraviolet B monotherapy.
Treatment with NB-UVB monotherapy is recommended for guttate psoriasis patients, regardless of their age.
For appropriate patients with generalized plaque psoriasis, home-based NB-UVB phototherapy is recommended as an alternative to in-office NB-UVB phototherapy.
Treatment with NB-UVB phototherapy is recommended for pregnant patients who have guttate psoriasis or generalized plaque psoriasis.
As a measure to possibly improve efficacy, NB-UVB phototherapy can be safely augmented with concomitant topical therapy using retinoids, vitamin D analogues, and corticosteroids.
Oral retinoids can be combined with NB-UVB phototherapy in appropriate patients with generalized plaque psoriasis if they have not responded adequately to monotherapy.
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Can You Experience Remission Without Treatment
Its generally recommended to treat your psoriasis. Psoriasis has a chronic relapsing nature, and poorly controlled psoriasis may increase the risk of having other types of psoriasis.
However, if someone has achieved complete remission for at least one year, their doctor may recommend stopping therapy with careful follow-up. You should always talk to your health care provider for medical advice if youre interested in discontinuing your medications.
Whats The Difference Between Guttate And Plaque Psoriasis
Plaque psoriasis is the most common form of psoriasis. It is said to affect up to 90% of people who suffer from psoriasis. Although both plaque psoriasis and guttate psoriasis have the same scale-like appearance, plaque psoriasis appears as red lesions with the scale look, while guttate psoriasis appears as tiny red spots with the scale look. Guttate psoriasis spots dont tend to be as thick as the lesions that appear when suffering from plaque psoriasis.
Plaque psoriasis tends to start by appearing on the elbows, knees and scalp, while guttate psoriasis usually starts appearing on your torso, arms and legs. Plaque psoriasis lesions tend to be from 110cm in size, while guttate psoriasis spots tend to be around 1cm in size.
Also, unlike plaque psoriasis, guttate psoriasis generally doesnt come back. However, plaque psoriasis tends to come back when youre run down in the form of a flare-up.
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Is Psoriasis Caused By Stress
Often, patients wonder about the link between stress and psoriasis. Does stress automatically trigger a psoriasis outbreak? And how do people with psoriasis manage stress to avoid an outbreak? Unfortunately, there is no simple, one-size-fits-all answer to these questions. While there is a link between stress levels and psoriasis flare-ups, it can be very different depending on the person, the severity of their psoriasis, and the type of psoriasis they are suffering from. Some of the things you can do to ease your mind and help keep your stress levels under control when dealing with psoriasis include the following:
- Visit a dermatologist when you notice signs of psoriasis. Your dermatologist will help you determine the exact type of psoriasis you have, medications that may help you, and triggers you should avoid. They can also help put your mind at ease about your condition, which can reduce some of the added stress you may be feeling.
- Try taking a walk or meditating to help control your everyday stress levels. Not only can these activities help your body stay in good shape, but they can also help to clear and calm your mind.
- Trust your dermatologist and be open to new treatments. Your doctor is constantly learning about the best treatment options for psoriasis and can help steer you toward a better option when your psoriasis is not getting better with other treatment options.