Guttate Psoriasis

Guttate psoriasis is a type of psoriasis characterized by the spontaneous eruption of small, teardrop-shaped skin lesions. "Guttate" means "resembling drops." This form of psoriasis gets its name from the shape of its papules (bumps), which look like a rash with lots of red blotches scattered across an area of skin.

In most cases, guttate psoriasis is triggered by group A Streptococcus (group A strep) bacterial infections, such as strep throat. Children and adolescents are more likely to develop guttate psoriasis, but people of all ages are susceptible. About 1 in 3 people who experience acute guttate psoriasis when they're younger develop chronic plaque psoriasis in adulthood.

Guttate psoriasis usually is a non-chronic (i.e., not long-lasting) type of psoriasis. Tonsillitis and other bacterial or viral infections, such as an upper respiratory infection, can also trigger an attack of guttate psoriasis symptoms. When triggered by infectious disease, symptoms typically appear two to three weeks after the initial infection.

Symptoms and Appearance

Guttate psoriasis gets its name from the teardrop-shaped bumps (papules) that spontaneously erupt when something triggers an outbreak. Unlike other types of psoriasis that tend to form in blotchy patches, guttate psoriasis looks like lots of little drops scattered across the skin, almost like dozens of raindrops beading on the hood of a car. These raised and reddish-colored psoriatic "drops" resemble pimples but are called papules.

Acute Guttate Psoriasis vs. Chronic Plaque Psoriasis

Unlike plaque psoriasis, which is characterized by larger patches of thick, scaly erythematous (red) skin, guttate psoriasis usually looks like dozens of teardrop-shaped spots scattered across an area of skin. Both of these types of psoriasis are inflammatory autoimmune diseases that aren't contagious.

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Causes and Triggers

Historically, the most common known cause/trigger of acute guttate psoriasis has been streptococcal infection. Since 2020, however, there have been isolated case reports of guttate psoriasis being triggered by SARS‐CoV‐2 infection, the virus that causes COVID-19.

A family history of psoriatic disease and stressful life events are also risk factors for a first episode of acute guttate psoriasis.

Stages of Guttate Psoriasis

Guttate psoriasis doesn't have progressive stages but is categorized based on a severity scale ranging from mild to severe guttate psoriasis. Although the terms "mild," "moderate," and "severe" are often used when describing the degree of severity of psoriasis, there is no consensus on what each category encompasses.

Guttate Psoriasis Treatment

Acute guttate psoriasis typically goes into spontaneous remission after a few weeks or months. Although there are guttate psoriasis treatments that can alleviate symptoms, there is no cure, and there isn't a single gold standard or routine treatment for guttate psoriasis.

Guttate psoriasis isn't a contagious skin disease. However, because an outbreak of guttate psoriasis is usually triggered by an immune system response to an underlying infection, taking steps to prevent catching a bacterial or viral infection (e.g., washing hands, wearing a mask in public) in the first place can lower the risk of having a guttate psoriasis episode.

Topical Treatments

Guttate psoriasis treatments such as topical corticosteroids can alleviate itchiness (pruritis) and reduce skin inflammation, which can help the healing process. Coal tar is a century-old remedy for psoriasis; it's a safe and inexpensive topical treatment.

Phototherapy

Phototherapy for psoriasis involves exposing the skin to an artificial light source such as ultraviolet B (UVB) or psoralen ultraviolet A (PUVA). Laser treatments like intense pulsed light (IPL) or light-emitting diodes (LED) are also considered phototherapies. Guttate psoriasis is most responsive to PUVA phototherapy.

Other Medications

In severe cases, a healthcare provider such as a skin specialist (dermatologist) may prescribe an oral corticosteroid for the inflammation associated with guttate psoriasis.

Notably, medications used to treat severe plaque psoriasis—such as Soriatane (acitretin) or Trexall (methotrexate)—are not used to treat acute guttate psoriasis. Similarly, biologic drugs like Talz (ixekizumab) or Tremfya (guselkumab) are only prescribed for guttate psoriasis in rare cases when teardrop-shaped guttate lesions progress into plaques.

 Lifestyle Changes

Stress-relief strategies and taking steps to boost your immune system naturally are lifestyle changes that can lower your risk of developing guttate psoriasis. Healthy habits like staying active and not smoking or drinking too much can reduce inflammation and the severity of psoriasis.

Long-Term Outlook for Guttate Psoriasis

The long-term outlook for people with guttate psoriasis is favorable. A longitudinal study published in 2021 examined the long-term outcome of psoriasis patients over the course of a decade and found that even without any treatment, 48% of patients with guttate-onset psoriasis had minimal disease activity during these 10 years.

Complications

Scratching itchy skin during a guttate psoriasis outbreak can worsen symptoms and slow healing. There isn't a surefire way to stop psoriatic skin patches from itching, but taking steps to avoid excessive scratching can offset these complications.

Summary

Guttate psoriasis is a skin disorder characterized by reddish teardrop-shaped bumps that look like they've been splattered across the skin. Unlike plaque psoriasis, which usually forms in much larger patches, guttate psoriasis looks more like a rash with dozens of pimple-sized spots.

The most common cause of guttate psoriasis is a bacterial infection like strep throat or a virus. Stressful life events and a family history of psoriasis are also risk factors for having a guttate outbreak. In most cases, guttate psoriasis clears up and heals itself in a few weeks or months.