Psoriasis is a chronic inflammatory immune-mediated disease that causes increased skin cell growth and itchy spots and thick, scaly patches on the skin. It can also affect other organ systems, including the joints. Guttate psoriasis is a form of psoriasis that presents as drop-like, red, pink, violet, or brown scaly spots and patches on the skin.

Guttate psoriasis is a variant of psoriasis usually triggered by an untreated streptococcal infection, among other causes, and can present as raised, itchy, pink, or red scaly spots. In darker skin tones, these spots can appear violet or brown. The name comes from the Latin word “guttate,” meaning “drop.”

Guttate psoriasis is not common. Less than 30% of psoriasis is guttate psoriasis. It usually presents in children and adults under the age of 30 years.

This article discusses guttate psoriasis, its effects, possible causes, and treatment.

Guttate psoriasis develops with characteristic small, red, violet, or brown scaly skin patches resembling drops.

Unlike guttate psoriasis, plaque psoriasis lesions are usually larger, itchy plaques that can be covered in a thick scale, often described as “silvery.”

Plaque psoriasis also usually occurs on the trunk, scalp, elbows, and knees, whereas guttate psoriasis can occur anywhere on the skin.

Several hundred of these small, drop-shaped patches may appear on the arms, legs, torso, scalp, face, and ears.

Patches can appear almost anywhere on the body but often occur on the:

  • elbows
  • knees
  • scalp
  • lower back
  • arms
  • legs
  • ears
  • face

Psoriasis can affect the skin of the fingernails and toenails. It can also affect the armpits, groin, and under the breasts, where it can develop as inverse psoriasis. This is when psoriasis develops inside the folds of the skin.

Guttate psoriasis rarely occurs inside the mouth, on the gums, or inside the cheeks. Guttate and plaque psoriasis can occur at the same time.

How does guttate psoriasis present on dark skin?

Guttate psoriasis generally causes small pink, violet, or brown spots. In darker tones, it may be harder to see the changes to the skin, and people are more likely to experience hyperpigmentation. Hyperpigmentation occurs when patches of skin become darker than the surrounding area.

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Guttate psoriasis on the right hand.
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Guttate psoriasis on the back.
Photography by DermNet New Zealand
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Guttate psoriasis on the back.
Photography courtesy of Gzzz/Wikimedia
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Guttate psoriasis on the upper back.
Photography courtesy of Bobjgalindo/Wikimedia
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Guttate psoriasis on the abdomen, causing small, red, drop-like skin lesions.
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Guttate psoriasis on the lower leg.
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An outbreak of guttate psoriasis is usually manageable, but as the rash can be very itchy, a person can get a secondary skin infection from scratching.

Even if a person receives no treatment, guttate psoriasis typically resolves on its own in 3–4 months. However, about 25% of people with guttate psoriasis will develop chronic plaque psoriasis.

A person who develops chronic plaque psoriasis can have other comorbidities, including:

Guttate psoriasis can develop very quickly. It is not clear what makes the immune system overreact, but a variety of different triggers can start flares. These include:

  • upper respiratory infections
  • streptococcal infections
  • tonsillitis
  • stress
  • injury to the skin
  • certain drugs, including antimalarials and beta-blockers
  • genetic predisposition

In addition, there are reports of Covid-19 triggering cases of guttate psoriasis.

Guttate psoriasis is not contagious. However, a contagious infection, such as strep throat from the Streptococcus bacteria, is often responsible for flares of guttate psoriasis. Symptoms typically show 2–3 weeks after infection. It is the only type of psoriasis that progresses due to an acute viral or bacterial infection.

It is possible to have strep throat or another viral or bacterial infection without showing symptoms. For this reason, guttate psoriasis might seem to have a sudden, unexplained onset.

Guttate psoriasis might also have genetic causes. A person has a higher risk of developing the disease if it runs in their immediate family.

A doctor, usually a dermatologist, will typically diagnose guttate psoriasis by physical examination of the skin. A dermatologist can often diagnose guttate psoriasis based on the appearance and the person’s medical history.

The doctor or dermatologist may need to take a skin sample and perform a biopsy to confirm the diagnosis.

A blood test can check if a person has or recently had a strep infection, which is the most common cause of the condition.

This is especially important because some people may have the bacteria but not experience any symptoms, such as those of strep throat.

A doctor may also ask about any recent bouts of strep throat or other infections, as these may trigger guttate psoriasis in children. They may also order a throat swab to test for infections.

Similar conditions

Several conditions have symptoms similar to the skin involvement of guttate psoriasis.

These include:

These conditions might occur alongside an outbreak of guttate psoriasis. An important part of diagnosis will be ruling out these alternative explanations for symptoms.

Treating guttate psoriasis can be challenging. It is important to rule out untreated strep infection as a cause of guttate psoriasis, as a doctor can treat this with oral antibiotics, and the rash should resolve.

People with guttate psoriasis should use topical medications as the first step. The direct application of topical medicines to the lesions can moisturize the area and relieve itching.

If a person has Streptococcus bacteria, the treatment will be a course of antibiotics. In addition, typical treatments for guttate psoriasis include:

Antidandruff shampoo can help with dryness and itching on the scalp. A person may also get phototherapy, which is a treatment that uses ultraviolet light, with either narrow or broadband UVB treatment.

Some natural remedies and lifestyle changes that may help with guttate psoriasis include:

  • spending time in sunlight for short monitored periods to help minimize its severity
  • adding Epsom or Dead Sea salts to bathwater and soaking in it. These salts help reduce inflammation, remove built-up dead skin cells, provide hydration, and soothe the skin.
  • avoiding soaps that contain perfumes, as these may irritate the skin
  • keeping a daily exercise routine to help strengthen muscles and tissues. This can help regulate the body’s metabolic functions, help the person maintain a healthy weight, and reduce the risk of cardiovascular disease and metabolic syndrome, which can sometimes accompany psoriasis.

It is important not to use exfoliating products and not scratch the area, as this can worsen a person’s symptoms.

Guttate psoriasis is an immune-mediated inflammatory disorder. A person might not be able to prevent the disease if they have a family history of psoriasis. However, smoking and excessive alcohol consumption can increase the likelihood of symptoms developing.

Sometimes, psoriasis may leave a person feeling self-conscious. Self-care tips may include wearing loose clothing to feel more comfortable and avoiding certain foods that may trigger symptoms.

A person with psoriasis might also benefit from counseling or psychotherapy to work through any feelings of depression or anxiety.

It is important to monitor for symptoms and any signs of relapse to ensure prompt treatment.

A healthful diet may help lessen the effects of guttate psoriasis. The results of a 2017 survey suggest that following certain diets, such as a vegan or Mediterranean diet, can help reduce the regularity and severity of some immune-related conditions.

Although no dietary measures directly relieve guttate psoriasis symptoms, some can help support active psoriasis treatment. These measures include:

  • diet plans that promote weight loss
  • gluten-free foods, as celiac disease is likely to develop alongside psoriasis
  • foods that act against inflammation, such as oily fish
  • good sources of antioxidants, such as leafy green vegetables
  • sources of vitamin D

Learn more about dietary measures that can help people with chronic psoriasis.

How do I reduce itching with guttate psoriasis?

Both guttate psoriasis and plaque psoriasis can cause itching, but it is likely to be on a larger scale if you have guttate psoriasis. A person can try applying a moisturizer or scale softening product, or take a cold bath. In addition, avoiding known triggers is key to helping reduce the itch.

If the itch is too overwhelming, prescription steroids or antihistamines can help reduce the symptoms and inflammation, which can help reduce the itching.

How long does guttate psoriasis last?

There is no cure for guttate psoriasis. Guttate psoriasis will typically resolve in 3–4 months on its own. Some people may never get it again, while for others, it may come back with another strep infection. People who experience guttate psoriasis for a year or longer are more likely to develop chronic plaque psoriasis.

How do I stop guttate psoriasis from spreading?

The best way to stop psoriasis from spreading is to continue with a regular course of treatment. This can include both medical and natural remedies. In addition, a person can do their best to avoid scratching or traumatizing the skin and wear comfortable clothing.

A doctor can diagnose and treat guttate psoriasis effectively. Often, the rash clears completely, even without treatment. However, in about 25% of people, it develops into chronic plaque psoriasis.

A person could develop guttate psoriasis more than once if they are reinfected with the Streptococcus bacteria, which is the most common cause.

If a person is experiencing symptoms, they should visit a doctor to rule out other conditions that may present similarly. If a person has secondary syphilis, for example, they are at risk for serious systemic complications.

More information and resources for people living with psoriasis are available at our psoriasis hub.