What to know about guttate psoriasis
This type of psoriasis can appear at any age, but it generally starts to develop in childhood or young adulthood.
In this article, learn all about guttate psoriasis, including its effects, possible causes, and how to treat it.
Guttate psoriasis causes small, red, tear-shaped patches to form on the skin
Image credit: Bobjgalindo, 2010.
The name guttate psoriasis comes from the Latin word guttate, which means "drop."
The condition has this name because its characteristic small, red, scaly skin patches resemble tears or raindrops.
While the lesions in plaque psoriasis are large with a covering of thick, silvery scales, the patches in guttate psoriasis are much smaller and thinner.
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:
- lower back
- soles of the feet
Psoriasis can also affect the fingernails, toenails, and mouth. Guttate and plaque psoriasis might occur at the same time.
An outbreak of guttate psoriasis is usually manageable, but complications can arise if a person does not receive treatment.
Potential symptoms include pain, secondary skin infection, and itching.
The complications of guttate psoriasis include:
- psoriasis arthritis
- cardiovascular disease and high blood pressure
- Crohn's disease
- liver and kidney disease
- other autoimmune disorders
- eye conditions
Doctors classify psoriasis according to its severity, which they determine by looking at how much of the body the symptoms are affecting.
- Mild: Lesions develop on up to 3% of the skin.
- Moderate: Lesions cover 3% to 10% of the skin.
- Severe: Psoriasis covers more than 10% of the skin.
Sometimes the rash resolves, but it may return later.
A dermatologist will examine the skin to determine the presence of guttate psoriasis.
A doctor, usually a dermatologist, will typically diagnose guttate psoriasis by performing a physical examination of the skin. The dermatologist can determine whether pustules result from guttate psoriasis by their visual appearance.
The doctor or dermatologist may need to take a skin sample and perform a biopsy to confirm the diagnosis. Blood tests can rule out other possible diseases, such as eczema or dermatitis.
The doctor may ask about any recent bouts of strep throat or other infections, as these may act as a trigger for guttate psoriasis in children. They may also order a throat swab to test for infections.
The doctor will assess the severity of the breakout using the Physician Global Assessment (PGA) and the Psoriasis Area and Severity Index (PASI). They will also suggest the best ways to prevent future flares.
Several conditions have symptoms that are similar to the skin involvement of guttate psoriasis.
These conditions might occur alongside an outbreak of guttate psoriasis. An important part of diagnosis will be ruling out these alternative explanations for symptoms.
A doctor can treat early stage psoriasis effectively. Sometimes, the rash clears completely, but guttate psoriasis can cause further flares of skin symptoms in some people.
However, if a person does not seek medical treatment, symptoms may become severe. At this stage, guttate psoriasis becomes difficult to treat, and it may become a chronic health condition.
Guttate psoriasis can develop very quickly. It is not clear what makes the immune system overact, but a variety of different triggers can start flares.
- upper respiratory infections
- streptococcal infections
- injury to the skin
- certain drugs, including antimalarials and beta-blockers
- dysfunction of the nervous and endocrine systems
- hormonal disorders
- genetic predisposition
- environmental risks
- excessive alcohol consumption
Guttate psoriasis is not contagious, but a contagious infection, such as strep throat, 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.
Light therapy uses ultraviolet light to treat patches of psoriasis.
Treating guttate psoriasis can be challenging.
It is important to have appropriate treatment for guttate psoriasis to resolve ongoing discomfort and prevent complications.
People with mild 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.
Topical treatments for guttate psoriasis include steroid creams, gels, ointments, and vitamin D treatments. People can purchase many of these over the counter (OTC) and use them at home.
Antidandruff shampoo can help with dryness and itching on the scalp.
Other treatment options may include:
- phototherapy, which uses ultraviolet light
- antibiotics to treat strep throat or any other infection
- drugs, either by mouth or injection
Natural remedies and lifestyle changes
Some natural remedies may be beneficial:
Short monitored periods of sunlight can help minimize the severity of guttate psoriasis.
- Adding Epsom or Dead Sea salts to bathwater and soaking in it can help. These salts help reduce inflammation, remove built-up dead skin cells, provide hydration, and soothe the skin.
- People should avoid using soaps that contain perfumes, as these may irritate the skin.
- A daily exercise routine can help a person strengthen their muscles and tissues. Doing this can help regulate the body's metabolic functions and reduce the risk of cardiovascular disease and metabolic syndrome, which can sometimes accompany psoriasis.
Guttate psoriasis is an autoimmune 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 increase the likelihood of symptoms developing.
With proper treatment, individual outbreaks of lesions are likely to resolve in full. However, the skin involvement of guttate psoriasis may flare up later on, causing further symptoms.
If psoriasis makes a person feel self-conscious, they can try using clothing or makeup to cover lesions. 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.
Diet and psoriasis
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 flares.
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
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.
Often, a moisturizer, cold shower, or scale softening product will help relieve the itch. Identifying any triggers of your guttate psoriasis is key to helping reduce the itch because if you can avoid the trigger itself, there are more ways to reduce the flare-up and resulting itch.
For example, if stress triggers your symptoms, you can try practicing meditation. If the itch is too overwhelming, prescription steroids or antihistamines can help you control the urge to scratch.Debra Sullivan, PhD, MSN, RN, CNE, COI Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.