Guttate Psoriasis

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Introduction

What is guttate psoriasis?

Guttate psoriasis is a subtype of psoriasis—an autoimmune skin disorder. It affects about 8 to 10% of the more than 8 million Americans with psoriasis. This makes it the second most common form of the disease after plaque psoriasis. 

‘Gutta’ is the Latin word for a drop of fluid. Guttate psoriasis causes small, drop-like papules—or spots. They are typically raised and red with a silvery, scaly appearance. The spots most commonly show up suddenly on the arms, legs and torso. While the exact cause is not well understood, there are known triggers. The most common one is a strep infection, such as strep throat. However, guttate psoriasis is not contagious and won’t spread to others. Other infections, skin injuries, and other triggers can also provoke an episode.

Children, teens, and even young adults are most likely to get guttate psoriasis. There does not seem to be any race or sex differences in its occurrence. Doctors believe genes and other immune system factors may make some people more likely than others to get the disease.

Doctors treat guttate psoriasis with topical ointments, oral medicines, and light therapy. When an active infection is present, antibiotics may be necessary. Mild cases may go away without treatment. Severe or persistent cases of guttate psoriasis may require medicines to suppress the immune system. Once the symptoms clear, guttate psoriasis may never come back. However, some people have the condition for life or go on to develop plaque psoriasis.

See your doctor if you develop symptoms of guttate psoriasis. You may need testing for strep throat if you have guttate psoriasis without any obvious signs of infection. It is possible to have strep throat and not realize it.


Symptoms

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 stages—the 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 

  • Red, pink or salmon colored

  • Silvery, flaky scales (of dead skin) covering the surface

Guttate psoriasis bumps are usually temporary and may go away on their own within a few weeks. However, it is important to see your doctor if you have symptoms of the condition. You may have an underlying strep infection that needs treatment. It is also possible to develop chronic guttate psoriasis or plaque psoriasis after an episode.


Causes

What causes guttate psoriasis?

Like other forms of psoriasis, doctors do not have a full understanding of the cause of guttate psoriasis. Psoriatic disease, which includes guttate psoriasis, is an autoimmune disease. This means the immune system mistakenly attacks the body’s own cells as if they were foreign invaders. In psoriasis, the immune system does not attack skin cells directly. Instead, the immune system is abnormally activated in the skin and causes mass production of skin cells. The abnormal immune process also results in inflammation and blood vessel growth to supply the new skin tissue. Doctors aren’t exactly sure why this happens, but certain things seem to trigger it. 

The most common trigger of guttate psoriasis is a strep throat infection with group A Streptococcus. In these cases, something from the strep bacteria activate the abnormal process in the immune system. Up to 80% of people with guttate psoriasis have a strep infection. It typically develops 1 to 3 weeks after strep throat. However, strep throat does not always cause obvious symptoms. So, developing guttate psoriasis may be a clue to an underlying infection. While strep throat is contagious and can spread to others, guttate psoriasis is not contagious.  

Other possible triggers include:

  • Certain medicines, including antimalarial drugs and beta blockers

  • Excessive alcohol use

  • Other bacterial or viral infections, including upper respiratory infections and tonsillitis

  • Stress

  • Sunburn and other skin injuries, such as cuts, burns, or insect bites

Risk Factors

What are the risk factors for guttate psoriasis?

Guttate psoriasis usually occurs in people younger than age 30, and is most common in children and adolescents. It affects all races and both sexes. Up to 10% of people with plaque psoriasis will develop guttate psoriasis. But you do not have to have plaque psoriasis to develop the disease. 

Reducing your risk of guttate psoriasis

It is not always possible to prevent guttate psoriasis. See your doctor if you have a sore throat with fever, headache or rash for more than 48 hours. These symptoms could mean you have strep throat. Early diagnosis and treatment of strep throat may prevent guttate psoriasis and psoriasis flares.


Treatments

How is guttate psoriasis treated?

If your doctor diagnoses a strep or other bacterial infection, antibiotics can help clear it. Mild cases of guttate psoriasis usually respond to home treatment. This can include:

  • Medicated shampoos when the scalp is affected

  • Moisturizers

  • Topical corticosteroid ointments

  • Topical retinoids or vitamin D analogs

Moderate to severe cases may require light therapy in combination with oral medicines to suppress the immune system. Oral medicines can include cyclosporin (Gengraf, Neoral, Sandimmune), methotrexate (Rheumatrex, Trexall), and biologics. Light therapy—or phototherapy—involves exposing the skin to UV (ultraviolet light). Most often, doctors use a drug, psoralen, that sensitizes the skin to UVA light. This slows down skin cell turnover and can clear symptoms. The combination of psoralen and light therapy is called PUVA. Guttate psoriasis is very responsive to PUVA. 


Complications

What are the potential complications of guttate psoriasis?

Guttate psoriasis may clear and never return. However, some people will have the condition for life. About 40% of the time, people with guttate psoriasis will go on to develop plaque psoriasis at some point during their lifetime. It is also possible to develop psoriatic arthritis following guttate psoriasis. Unfortunately, there is not a clear understanding of why some people have no complications and others do. So, doctors can’t predict what will happen after an episode of guttate psoriasis.


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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Aug 12
  1. About Psoriasis. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis 
  2. Guttate Psoriasis. Medscape. https://emedicine.medscape.com/article/1107850-overview#a11 
  3. Guttate Psoriasis. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/types/guttate 
  4. Guttate Psoriasis. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/000822.htm 
  5. Immune System and Psoriatic Disease. National Psoriasis Foundation. https://www.psoriasis.org/research/science-of-psoriasis/immune-system 
  6. Phototherapy. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/treatments/phototherapy 
  7. Psoriasis: Signs and Symptoms. American Academy of Dermatology. https://www.aad.org/public/diseases/scaly-skin/psoriasis/psoriasis-signs-and-symptoms/psoriasis-signs-and-symptoms 
  8. Saleh D, Tanner LS. Psoriasis, Guttate. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482498/
  9. Statistics. National Psoriasis Foundation. https://www.psoriasis.org/content/statistics 
  10. Strep Throat. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/strep-throat/symptoms-causes/syc-20350338 


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