Last reviewed by Editorial Team on August 13th, 2018.
What is Guttate Psoriasis?
Guttate psoriasis is a type of psoriasis characterized by the eruption of tear-drop like papules in salmon-pink color and fine scales over the affected skin. The lesions of guttate psoriasis usually develop in the areas of the proximal extremities and the upper trunk but may also have a generalized distribution.
Guttate psoriasis is also referred to as Eruptive psoriasis and is often preceded by a streptococcal infection. It is a type of psoriasis that equally affects both male and female regardless of racial group. It is also regarded as the second most common type of psoriasis that can affect children as it usually occur in children and individuals under the age of 30 years. In general, however, guttate psoriasis is rather rare.
Guttate psoriasis is a variant of psoriasis where the latter is described as a chronic skin condition characterized by the development of thick and scaly patches of skin that may be reddish, whitish or silvery in color and is the result of rapid growth of skin cells. Guttate psoriasis is among the variant of psoriasis and next to plaque psoriasis which is regarded as the most common type of psoriasis. Guttate psoriasis is potential to develop into plaque psoriasis but the reddish and scaly lesion may completely heal without the need for treatment.
Guttate Psoriasis Symptoms
Guttate psoriasis is a non-fatal eruption of the skin that occurs acutely and develops in the areas of proximal extremities and the trunk. Prior to the onset of guttate psoriasis, it is preceded by a streptococcal infection usually of the upper respiratory tract such as pharyngitis and tonsillitis. Guttate psoriasis often follows within 2 to 3 weeks after the streptococcal infection has resolved.
The onset of lesion is acute and often with multiple lesions appearing on the proximal extremities and on the trunk. The lesions, however, may extend or spread to the face, scalp and ears. Itching or mild pruritus is often associated with guttate pruritis. Guttate psoriasis is noticeably worse during the cold or winter months and improves during the summer months just like the condition of psoriasis.
At closer look, the characteristics of the lesion in guttate psoriasis include the following:
- Multiple papules that are about 1 mm to 10 mm in diameter
- The papule is tear-drop or drop like in shape
- The papule is salmon-pink or reddish in color
- Fine scales are usually absent during the early stage of the lesion and become more apparent as soon as it become established
There may be no presence of changes in the nails such as pits and ridges which are characteristics of chronic psoriasis. The palm of the hands and the sole of the feet are usually spared from the lesions brought by guttate psoriasis.
Guttate psoriasis is believed to be influenced by different factors. The exact manner on how these factors trigger the onset of guttate psoriasis however remains unclear.
The factors considered to trigger the onset of guttate psoriasis include the following:
- Genetic factor is believed to play an important role to the onset of guttate psoriasis just like any other psoriasis. HLA-BW17 and HL-B13 genes are being linked to the incidence of guttate psoriasis. The exact mechanism of these genes in reacting towards the other microorganisms and molecules to produce guttate psoriasis remains unclear.
- Streptococcal infection is the most implicated in the onset of guttate psoriasis. Streptococcal infection of the upper respiratory tract infection in particular is the most linked to guttate psoriasis and has been recognized in the medical field for more than 5 decades. It is a precedent to guttate psoriasis where the eruption of skin usually occurs within 2 to 3 weeks after streptococcal infection such as pharyngitis and tonsillitis have subsided.
- Viral infection is also believed to trigger the onset of guttate psoriasis. Chickenpox, Roseola and rubella are some of the viral infections known to trigger guttate psoriasis in children, although the exact mechanism is still unclear.
- T lymphocyte activation through the production of cytokines is also considered a factor in influencing the proliferation of skin lesions in guttate psoriasis. The activation of T lymphocytes precedes the onset of guttate psoriasis.
- Medications or drugs are also among believed to trigger epidermal proliferation in guttate psoriasis. Drug for tumor necrosis factor blocker is being linked to the onset and worsening condition of guttate psoriasis.
Guttate psoriasis is a form of psoriasis that usually resolves within several weeks without the need for treatment. The treatment however depends on the severity or the extent of the epidermal lesion and will also depend on the choice of the patient. Other patients will seek treatment to get instant relief and relieve them from embarrassment brought by the unappealing appearance of the lesions.
The treatment of guttate psoriasis includes the following:
Phototherapy is indicated for guttate psoriasis that remains resistant despite pharmacological therapy. PUVA therapy is beneficial to many resistant cases where the therapy is a combination of psoralen drug and ultraviolet exposure. Narrowband UV-B phototherapy is a new method of treating guttate psoriasis which can be done even in the confines of the patient’s home and without the burden of going out and be exposed under the sunlight which is prohibited after the PUVA therapy.
Corticosteroid in topical form is found to be an effective treatment for guttate psoriasis. This method of treatment act as anti-inflammatory, vasoconstrictive, antiproliferative and immunosuppressive and is therefore beneficial to the cure of guttate psoriasis.
Antibiotic treatment is prescribed to guttate psoriasis if the onset is triggered by a streptococcal infection of the upper respiratory tract. A broad spectrum antibacterial medication may be given to treat the infection subsequently guttate psoriasis. Erythromycin acts as anti-inflammatory and anti-bacterial that this medication is often prescribed for the treatment. Rifampin is specially indicated for resistant streptococcal infection. It is often used in combination with Erythromycin or Penicillin and is taken orally for a period of five days. Penicillin is another medication for the treatment of guttate psoriasis although special precaution must be taken as it is contraindicated for those with allergic reaction to penicillin treatment.
Diet modification is found to be beneficial in the treatment and prevention of guttate psoriasis especially to those who are predisposed. Individuals are especially advised to eat that can lower the inflammatory response of their body and to avoid food that can force the immune system.
Gluten-free diet is found to be beneficial in patients suffering from guttate psoriasis. There has been no clear study to prove this type of diet but many patients particularly those with gluten intolerance found a gluten-free diet to be beneficial in diminishing the inflammation and other symptoms of guttate psoriasis.
Vitamin C, vitamin E, vitamin A and zinc are rich in antioxidants and fatty acids that are essential nutrient for the skin and especially help in the treatment and prevention of guttate psoriasis. These nutrients can be acquired by eating fruits, nuts, vegetables, seeds and legumes.
Guttate psoriasis is a skin condition that resolves spontaneously over the course of a few weeks. It resolves spontaneously even without the need for treatment. On the other hand, the symptoms can be managed with home remedies.
Home remedies for guttate psoriasis may include the following:
- Saltwater soak is the best home remedy without agitating further the skin eruption in guttate psoriasis
- Sunlight is another home remedy for guttate psoriasis due to the Vitamin D it produces. It is, however, not advised to stay too long under the sun enough to get a sunburn or suntan
- Application of aloe vera gel and garlic oil is beneficial to the skin to keep it moisturized