‘Guttate’ is taken from the Latin language word ‘gutta’ which means drop. This is one of the forms of psoriasis that is characterized by tiny salmon-pink coloured drops on the affected skin. Guttate psoriasis also exhibits scales as one in plaque psoriasis but in this form of psoriasis, scales are much finer. The size of the drop-like lesions varies from 1-10 mm in diameter. The most common sites affected by this form of psoriasis are trunk region and extremities, thus showing centripetal distribution. It most commonly affects individuals with less than 30 years of age.
Cause of Guttate Psoriasis
The most common cause which triggers the clinical manifestation of the disease is streptococcal infection. The sudden eruption of the skin lesions occur within three weeks of streptococcal infection. This sudden outbreak could also be due to acute aggravation of long standing case of plaque psoriasis. A person suffering from chronic plaque psoriasis can suddenly get episode of this form of psoriasis. Apart from streptococcal bacteria, other infections like cold or chickenpox can also lead to development of guttate psoriasis. The genetics also play its role in the pathogenesis of this disease.
Clinical manifestations of Guttate Psoriasis
These are some clinical manifestations given below;
- Appearance of small, multiple, salmon-pink coloured drop-like papules of 1-10 mm in diameter on the affected skin.
- Presence of fine scales in late stages of the lesion.
- Itching and pruritus of the affected skin.
- Centripetal distribution of the lesion first affecting the trunk and then moving towards extremities.
- History of streptococcal infections or other bacterial infections before the appearance of lesions
- Involvement of perianal or pharyngeal area in the cases having history of streptococcal infections.
- Involvement of nails like formation of nail pits or oil-drop sign is absent.
Management of Guttate Psoriasis
The management of guttate psoriasis depends on the pathogenesis of the disease. Usually, the symptoms of the disease remain from few weeks to months and then resolve without any treatment.
Use of emollients for treating the disease will be sufficient as first line of treatment. Topical steroids can also be used but the application of topical steroids can be little bit burdensome in case of extensive eruption as in Guttate psoriasis.
- Topical corticosteroids: These steroids act as anti-inflammatory and immunosuppressive. These steroids also show vasoconstrictive action. Strong steroids should be avoided at face or on infants or in the areas with thin skin. But these steroids can be used elsewhere on the other affected areas of the body. These steroids may act as the most effective treatment for thick plaques.
- Use of Antimicrobials: Antimicrobials like amoxicillin, penicillin etc. are also used because of the association of this disease with streptococcal infection. However, still, research need to be done to know the effectiveness of the antimicrobial therapy in the management of this disease.
- Phototherapy: To treat the severe cases, narrow band ultraviolet therapy (UV-B) is used. And if the case is quite resistant, then PUVA is recommended.
Complications in Guttate Psoriasis
Two major complications are there in Guttate psoriasis:
- The complications may include hypersensitivity, if the patient is allergic to penicillin. In that case, antimicrobial therapy should be discontinued or else patient should be put on other antimicrobial drugs like erythromycin.
- Long use of strong topical steroids can cause thinning of the skin or hypopigmentation of the skin.