Guttate psoriasis

Alternative names
Psoriasis - guttate

Definition
A form of psoriasis with characteristic water drop shaped scaly macules.

Causes, incidence, and risk factors
Guttate psoriasis is a relatively uncommon form of psoriasis. It is usually seen in patients younger than 30. Flares generally follow an infection, most notably Strep throat.

Psoriasis seems to be an inherited disorder, and it appears to be related to the immune or inflammatory response. It often is aggravated by injury or irritation (cuts, burns, rash, insect bites), and may be severe in immunosuppressed people (such as those who have chemotherapy for cancer, or with AIDS) or in people who have autoimmune disorders (such as rheumatoid arthritis). Medications, viral or bacterial infections, excessive alcohol consumption, obesity, lack of sunlight, overexposure to sunlight (sunburn), stress, cold climate, and frequent friction on the skin are also associated with flare-ups of psoriasis. The disorder is not contagious.

Normally, skin takes about a month for its new cells to move from the lower layers to the surface. In psoriasis, this process takes only a few days, resulting in the build-up of dead skin cells and formation of thick scales.

Symptoms

     
  • skin lesion (scaly macule)       o red       o usually covered with silvery scales       o discrete, demarcated, teardrop-shaped patches of skin       o usually located on the entire body       o with patchy loss of skin color  
  • itching

Signs and tests
Diagnosis is usually based on the appearance of the skin. There is often a history of recent sore throat. Your physician may choose to perform a skin biopsy or throat culture to help confirm the diagnosis.

Treatment

Treatment is focused on control of the symptoms and prevention of secondary infections. It varies with the extent and severity of the disorder.

If an infection can be identified, it should be treated with appropriate antibiotics.

Severe or resistant cases, or cases involving large areas of the body, may require intensive treatment or hospitalization. Mild cases are usually treated at home. Topical medications include:

     
  • prescription or nonprescription dandruff shampoos  
  • shampoos or lotions that contain coal tar  
  • cortisone or other corticosteroids  
  • lubricants  
  • Vitamin D containing medications (Dovonex)  
  • retinoids (Tazorac)

Oral or injected immunosuppressive medications (such as corticosteroids or methotrexate) may be used, but only in very severe cases. Other medications may include retinoids or cyclosporine.

Other treatments may include exposure to sunlight or phototherapy. The skin is sensitized by applying coal tar ointment or by taking oral psoralens (a medication that makes the skin sensitive to light). The person is then exposed to ultraviolet light.

To minimize flare-ups, maintain good general health. Avoid respiratory and other infections.

Expectations (prognosis)
Psoriasis is not curable, but it can be controlled with treatment.

Complications

     
  • pain  
  • severe itching  
  • complications secondary to treatments  
  • secondary skin infections

Calling your health care provider
Call for an appointment with your health care provider if symptoms indicate guttate psoriasis.

Johns Hopkins patient information

Last revised: December 8, 2012
by Brenda A. Kuper, M.D.

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