Guttate is from the Latin word “Gutta” meaning “drop.” The lesions in this type of psoriasis look like drops on the skin. These drops will appear on the trunk and limbs, and sometimes the scalp.
Guttate psoriasis usually comes on quite suddenly. It is sometimes preceded by a streptococcal infection or use of a medication. However, a variety of causes can precipitate an attack of guttate psoriasis. In a study of 100 pediatric psoriasis patients, it was found that the outbreak of guttate psoriasis had been preceded by one of the following events: sore throats or tonsillitis, a cold, chicken pox, immunizations, mechanical trauma, psychological stress, illness and the administration of antimalarial drugs.
The guttate eruption appears and becomes generalized within a matter of days. The eruption initially consists of red bumps on the skin, which are later covered by scaling. Usually this form of psoriasis clears well on its own, although in some individuals it may persist.
In some individuals, guttate psoriasis may reappear with successive attacks of tonsillitis. In those cases physicians often recommend removal of the tonsils to avoid recurrences of the psoriasis. Similarly, successive streptococcal infections in older individuals can lead to a recurrence of the guttate eruption. Penicillin has been used as a preventative therapy in some cases to avoid occurrence of an infection that will cause an outbreak of the guttate psoriasis.
It has been observed that in persons with psoriasis of the chronic plaque type, an acute guttate flare-up can develop following application to the skin of steroids under occlusive dressings (i.e. plastic film, saran wrap, etc.).
Guttate flare-ups in children tend to continue throughout the teenage years and into early adulthood, but decrease with age. However, the form can evolve into a chronic form of psoriasis. One study has estimated that 14% to 17% of chronic psoriasis cases were initiated by guttate outbreaks. On the other hand, a person may have a remission of several years after recovering from a generalized eruption of guttate psoriasis.
A number of treatments have been advocated for guttate psoriasis. Bland ointments are considered safest in the acute eruptive stages. Topical steroid creams are effective and helpful for itch. Ultraviolet light phototherapy can be also used to treat guttate psoriasis followed by application of topical preparations. Oral medications and biologic therapies can also be used in persistent cases.
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