Skin

Guttate Psoriasis: Diagnosis, Symptoms and Treatment

July 12, 2024

Psoriasis is a chronic inflammatory skin condition that can take different forms depending on skin color and tone. It generally presents with irritation and skin discoloration and can cause a skin rash with itchy, scaly patches. It is most commonly present on the knees, elbow, trunk, and scalp. One type of Psoriasis is Guttate Psoriasis.

What Is Guttate Psoriais?

Guttate Psoriasis is a type of Psoriasis. The condition is more common in children and youngsters than adults and has been linked to Group A Strep. It presents with an acute onset of inflammatory, small, drop-like lesions. These lesions respond well to phototherapies and topical creams.¹

How Common Is Guttate Psoriasis?

Psoriasis affects 4% of the North American population. However, prevalence in the world population is around 2%. Guttate Psoriasis accounts for around 30% of all cases of Psoriasis. It has a similar prevalence in both genders. However, it is more common in people under 30.²

What Is The Cause of Guttate Psoriasis?

The primary cause of Guttate Psoriasis is Strep Throat. Tonsillitis can also precede the condition. The condition’s onset typically occurs 1 to 3 weeks after these infections. Various triggers have been linked to the disease. These include infections, sunburn, genetic factors, and even cuts and burns etc. People with HIV or immunosuppression have a higher risk of developing Guttate Psoriasis. This form of Psoriasis has also followed TNF-alpha therapy.³ TNF-alpha therapy involves using TNF-alpha inhibitors to manage autoimmune and inflammatory conditions.
Research has also linked guttate psoriasis to the PSORS1 gene, which resides on chromosome 6p and carries the HLA-Cw6 allele. Other alleles linked to Guttate Psoriasis include HLA-B13 and HLA-B17.

How Do You Diagnose Guttate Psoriasis?

Doctors can diagnose Guttate Psoriasis clinically through a proper history and examination. The definitive test for psoriasis is a skin biopsy. Psoriasis lesions on biopsy may present with thickness, erythema, and abnormal keratinization. A biopsy can rule out other conditions, such as Pityriasis rosea, and may help find the type of Psoriasis.
Doctors may also prescribe Blood tests and throat cultures. These tests are done to test for Group A Strep, which has been linked to Guttate. Blood tests generally look for immune symptom markers such as anti-streptolysin “O” or anti-DNase B, which indicate recent infection.

What Are The Symptoms Of Guttate Psoriasis?

Symptoms of Guttate Psoriasis include characteristic lesions and spots. These generally occur on the arms, legs, and the trunk. Symptoms may include the following:

Patches of Itchy, pruritic skin.
Pinkish-red Tear drop lesions and spots
Silver, Flaky skin, and scaly spots
Koebners phenomenon: The occurrence of fresh psoriatic lesions on unaffected skin areas after an injury or trauma in individuals with psoriasis.

What Are The Stages Of Guttate Psoriasis?

It can be classified into three stages based on severity: Mild, Moderate, and severe. Different stages require different treatment modalities.

Mild Psoriasis: Lesions covering less than 3% of the skin. This form of the disease has relatively fewer lesions.
Moderate Psoriasis: It is characterized by lesions covering the skin in the range of 3 to 10%.
Severe psoriasis: It is characterized by lesions covering more than 10% of the skin.

What do Guttate Psoriasis lesions look like?

The lesions are drop-like and small (2 to 6 mm) in size. They are separate from each other, and they are more common on the torso. The color of the lesions can range from pink, reddish, or brownish, depending on skin color.⁴

Small, red, drop-like lesions of Guttate psoriasis are located at the hand (A) and the arm (B) of the patient. Image Courtesy: Koufakis, T., & Gabranis, I. (2014). The first presentation of guttate psoriasis triggered by acute tonsillitis. The Pan African Medical Journal, distributed under license CC BY

What Are The Treatments Of Guttate Psoriasis?

Treatment for Guttate Psoriasis depends on the severity and stage of the condition.⁵

In the management of mild Guttate psoriasis, the first-line treatment is the use of topical corticosteroids. These topical steroids are available as ointments, lotions, shampoos, etc. Ointment formulations are particularly effective due to their lipophilic properties. Avoid using corticosteroids if you have bacterial, viral, fungal infections, experience skin thinning, or are pregnant, or are breastfeeding. You can treat mild psoriasis with anthralin alone. Moreover, Anthralin, a topical cream, can be combined with topical corticosteroids as well.
Doctors typically use phototherapy as the first treatment for moderate to severe guttate psoriasis. Phototherapy can be administered alone or in combination with other treatments. It involves using broad or narrowband ultraviolet B treatments or photochemotherapy with ultraviolet A, which can include taking or applying psoralen. Psoralen can boost the amount of UV light the skin absorbs.
Several biological treatment options are currently available for managing plaque psoriasis. However, their effectiveness in treating guttate psoriasis has not been extensively studied. Emollient creams or ointments can help moisturize the skin and reduce dryness, which is common in psoriasis. In addition to the other modalities described earlier, salicylic acid can also be used to treat the condition.

What is the difference between Guttate Psoriasis, Secondary Syphilis, and Ptiyarisis Rosea?

Guttate Psoriasis typically results from streptococcal infections. It manifests as small, itchy, red lesions that may have silver, flaky scales covering them. Diagnosis involves clinical evaluation, skin biopsy, and medical history review. Guttate Psoriasis can be treated with corticosteroids, phototherapy, etc.
Secondary Syphilis is caused by Treponema pallidum.⁶ It presents with diverse symptoms, including rashes, fever, fatigue, and other systemic issues. The rash from syphilis appears as rough, red, or reddish-brown spots on the palms of the hands and the bottoms of the feet. Doctors diagnose syphilis through blood tests and treat it with antibiotics such as Benzathine penicillin G.
Pityriasis Rosea’s⁷ cause is unknown, but a viral or bacterial infection may cause it. It typically begins with a single, slightly raised, pink or red patch known as the “herald patch.” Following this, smaller, similar patches often appear on the chest, back, abdomen, and limbs in a pattern that resembles a Christmas tree. Doctors usually diagnose the condition through clinical examination, considering the characteristic appearance and distribution of the rash. Pityriasis Rosea often resolves on its own without specific treatment.

Are Guttate Psoriasis And Chronic Psoriasis The Same?

No, both conditions are different.⁸ For most patients, Guttate will resolve completely. However, almost a third of cases of Guttate Psoriasis may develop into chronic psoriasis. In Chronic Psoriasis, the patches of skin form large scaly “Plaques.”
Guttate psoriasis generally occurs in people under the age of 30, while Chronic Plaque Psoriasis occurs between 20 and 30 or 50 and 60 years of age. Chronic Plaque Psoriasis has a bimodal distribution. Bacterial infections are linked to Guttate psoriasis. However, triggers for Chronic Plaque Psoriasis vary for each person. Chronic plaque Psoriasis has larger red patches relative to Guttate Psoriasis and is also a lifelong condition.

What Are The Complications Of Guttate Psoriasis?

Guttate Psoriasis can lead to some complications, like skin depigmentation, that may lead to psychosocial effects. These may include mental health problems such as low self-esteem, anxiety, and depression. Skin lesions associated with the condition can also result in social isolation. These may contribute to a decreased quality of life. Moreover, Psoriasis has been linked to other complications⁹ such as:

Psoriatic Arthritis: This is a type of arthritis that can develop in individuals with psoriasis. It causes joint pain, stiffness, and swelling and can lead to joint damage if not properly managed.
Skin Infections: The psoriasis patches can sometimes become infected, especially if they are scratched or irritated. Bacterial and fungal infections are common.
Eye Problems: Psoriasis can affect the eyes in a condition known as “uveitis” or “iritis,” which causes eye redness, pain, and blurred vision.
Cardiovascular Disease: There is a higher risk of cardiovascular conditions, such as heart disease and stroke, in individuals with severe psoriasis.
Metabolic syndromes, including conditions like obesity, high blood pressure, and insulin resistance, which increase the risk of diabetes, are associated with psoriasis.

What Are Some Lifestyle Modifications For Guttate Psoriasis?

Adopting certain lifestyle changes can reduce outbreaks, resurgence, and symptoms of Guttate Psoriasis. These changes include:

Dietary changes:

Psoriasis symptoms can be made worse by eating certain foods. These foods can increase inflammation throughout the body. This irritation can make Psoriasis symptoms worse.¹⁰ People with Guttate Psoriasis should avoid alcohol and dairy products.

Moreover, they should also avoid food high in refined sugar, carbohydrates, and saturated and trans fats. Metabolism of these foods can lead to the production of inflammatory mediators, etc. For example, processed carbs in white bread and sugary items can spike blood sugar and increase inflammatory compounds such as Glycolated-end products, and sugary foods and drinks, along with artificial sweeteners, may lead to inflammation by spiking blood sugar and increase inflammatory proteins such as cytokines. These can, in turn, lead to a “flare-up” of the condition or worsen existing symptoms.

Smoking Cessation:

Smoking can lead to increased inflammatory cytokine production. This can lead to an increased risk of Psoriasis outbreaks and resurgence. It may also make existing Psoriasis symptoms worse.

Exercise:

Engaging in moderate to vigorous physical activity can serve as a preventive measure to lower the risk of developing psoriasis, and it may also help alleviate the condition’s severity, particularly in overweight individuals who use exercise as a weight loss strategy. Additionally, incorporating specific foods into your diet can aid in preventing psoriasis. For example, Whole-food balanced diets can reduce Psoriasis flare-ups. These foods include lean protein or vegetable protein. People with Psoriasis can also benefit from adding nuts, legumes, whole grains, and fruits and vegetables to their diet. Researchers have not demonstrated that vitamin supplements affect psoriasis.

Conclusion

Guttate Psoriasis, frequently triggered by strep infections, mainly affects young individuals. It presents with small drop-shaped lesions. Diagnosis involves clinical evaluation and tests, with treatment ranging from corticosteroids to phototherapy or biologics. It can lead to complications such as psoriatic arthritis, skin infections, eye problems, cardiovascular diseases, etc. Dietary management, exercise, and smoking cessation can help alleviate symptoms and reduce the risk of developing Psoriasis.

Refrences

1
Dupire G, Droitcourt C, Hughes C, Le Cleach L. Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database Syst Rev. 2019;3(3):CD011571. Published 2019 Mar 5. doi:10.1002/14651858.CD011571.pub2
2
Chimenti MS, Caso F, Alivernini S, et al. Amplifying the concept of psoriatic arthritis: The role of autoimmunity in systemic psoriatic disease. Autoimmun Rev. 2019;18(6):565-575. doi:10.1016/j.autrev.2018.11.007
3
Brandon A, Mufti A, Gary Sibbald R. Diagnosis and Management of Cutaneous Psoriasis: A Review. Adv Skin Wound Care. 2019;32(2):58-69. doi:10.1097/01.ASW.0000550592.08674.43
4
Koufakis T, Gabranis I. The first presentation of guttate psoriasis triggered by acute tonsillitis. Pan Afr Med J. 2014;17:273. Published 2014 Apr 14. doi:10.11604/pamj.2014.17.273.421
5
Saleh D, Tanner LS. Guttate Psoriasis. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482498/
6
Baughn RE, Musher DM. Secondary syphilitic lesions. Clin Microbiol Rev. 2005;18(1):205-216. doi:10.1128/CMR.18.1.205-216.2005
7
Schadt C. Pityriasis Rosea. JAMA Dermatology. 2018;154(12):1496. doi:https://doi.org/10.1001/jamadermatol.2018.3290
8
Guttate Psoriasis: Symptoms, Causes & Treatments. Cleveland Clinic. Accessed September 21, 2023. https://my.clevelandclinic.org/health/diseases/22812-guttate-psoriasis#:~:text=Guttate%20psoriasis%20isn
9
Carvalho AV, Romiti R, Souza CD, Paschoal RS, Milman LM, Meneghello LP. Psoriasis comorbidities: complications and benefits of immunobiological treatment. An Bras Dermatol. 2016;91(6):781-789. doi:10.1590/abd1806-4841.20165080
10
Psoriasis Diet: Foods to Eat and Avoid If You Have Psoriasis. www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/psoriasis-diet-foods-to-eat-and-avoid-if-you-have-psoriasis

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