Guttate Psoriasis

“Guttate” stems from the Latin word for “drop.” Though guttate psoriasis is the second most common form of psoriasis, it’s still relatively uncommon. Only about 4 percent of people in the United States who have psoriasis have the guttate form.

Guttate psoriasis is typically a young person’s condition. It primarily affects children, adolescents, and adults under 30 years of age, though it can occur at any age. Respiratory illnesses or viral infections are common triggers.

Guttate psoriasis causes spots that aren’t very thick, unlike plaque psoriasis, which causes raised lesions. Guttate spots are also typically small. They may have a covering of thin, flaky skin called scales.

Guttate psoriasis isn’t contagious. It can’t spread to others through skin-to- skin contact.

Spots often clear up with minor treatment. Guttate psoriasis may be a lifelong condition for some, or it may appear later as plaque psoriasis.

What are the symptoms of guttate psoriasis?

Guttate psoriasis flare-ups are often sudden. The breakouts typically involve small, discolored marks that intensify and expand. They can cover large portions of the body or may remain in smaller patches.

Guttate psoriasis lesions typically appear:

  • small in size
  • red or dark pink
  • separate from each other
  • on the torso or limbs
  • thinner than plaque psoriasis lesions

Outcomes vary for guttate psoriasis. In most cases, guttate psoriasis usually fades away by itself within a few weeks to a few months.

After that, there are several possible outcomes. Researchers don’t know yet how to predict which one will occur:

  • You may never get it again.
  • It may recur intermittently.
  • It may develop into chronic plaque psoriasis.

Forty percent of guttate psoriasis cases develop at some point into chronic plaque psoriasis.

What causes or triggers guttate psoriasis?

The exact cause of psoriasis is unknown, although researchers believe it stems from a combination of genetic, environmental, and immune system factors.

How is the immune system involved?

In the past several decades, researchers have identified psoriasis as a chronic immune-mediated disease.

Immune-mediated diseases are thought to be triggered by an abnormal immune response. An overly active immune system attacks healthy cells as if they were foreign invaders.

In psoriasis, the immune system targets the skin, which results in the rapid growth of skin cells. This causes the redness and flaky skin typical of psoriasis.

What are the triggers of guttate psoriasis?

Although the cause of guttate psoriasis is unknown, researchers have identified a link between bacterial or viral infections and the condition’s onset.

In particular, strep throat and tonsillitis frequently precede guttate psoriasis, especially in children. Infections usually occur 1 to 3 weeks before the onset of guttate psoriasis.

Other factors may also trigger a guttate psoriasis outbreak, including:

  • a skin injury, like a cut, an insect bite, or a burn
  • sunburn
  • stress
  • some medications, including antimalarial drugs and beta-blockers (drugs used to treat heart disorders)
  • smoking cigarettes

What are the stages of guttate psoriasis?

All forms of psoriasis, including guttate psoriasis, have three stages. The National Psoriasis Foundation (NPF) lists these stages as:

  • Mild. There are only a few lesions, which cover about 3 percent of your skin.
  • Moderate. Lesions cover between 3 percent and 10 percent of your skin.
  • Severe. Lesions cover 10 percent or more of your body, sometimes the entire body.

Your dermatologist will gauge the stage of your condition by how much of your skin is covered with lesions as well as its effect on your life. They’ll probably use two assessment scales, the Physician’s Global Assessment (PGA) and the Psoriasis Area and Severity Index (PASI).

How is guttate psoriasis diagnosed?

Your doctor can identify signs of guttate psoriasis during a physical examination. Your doctor will likely refer you to a dermatologist for a proper diagnosis.

The dermatologist will examine your skin and make note of the affected areas. This mapping will help them track treatments after diagnosis.

They’ll also take a complete medical history to rule out other conditions, like an allergic reaction. People often have allergic reactions to the antibiotics used to treat the infection that precedes the guttate psoriasis outbreak.

Your dermatologist can usually diagnose guttate psoriasis by examining your skin. But the following conditions may occasionally be mistaken for guttate psoriasis:

  • tinea corporis (ringworm of the body)
  • secondary syphilis
  • nummular eczema
  • pityriasis rosea (Christmas tree rash)
  • scarlet fever rash, which can occur after strep throat

Your dermatologist may also order a skin biopsy to eliminate other possible contributors to the skin lesions and to help determine the type of psoriasis.

What are the treatment options for guttate psoriasis?

Treatments for guttate psoriasis vary according to the severity of the condition. If it’s your first outbreak, no treatment may be needed. Since guttate psoriasis will usually clear up on its own within several weeks or months, a wait-and-see approach may be fine.

If you decide to forego treatment, consult with your dermatologist about a diagnosis and to discuss if this is the best option for you. If the condition returns or develops into plaque psoriasis, treatment will probably be necessary.

Topical steroid treatments

The most common treatments for psoriasis are topical corticosteroids. They’re made from natural hormones created by the body’s adrenal glands. Topical corticosteroids can help by reducing redness, itching, and inflammation.

Mild topical corticosteroids are available over the counter (OTC) and are often sufficient for mild cases. Stronger versions come by prescription from your doctor.

Topical corticosteroids can be used on their own, but they’re often combined with other treatments for moderate to severe cases. They are usually applied once or twice per day. Once your condition has been managed, treatment is usually paused.

It’s always best to consult a medical professional before using corticosteroids. Long-term use of topical corticosteroids can cause thinning of the skin, also known as atrophy.

Topical nonsteroidal treatments

Your doctor may prescribe a topical nonsteroidal treatment if topical corticosteroids aren’t right for you. Prescription nonsteroidal topical treatments often include ingredients like:

  • Synthetic vitamin D3. This is used to slow skin cell growth. It’s also sometimes combined with a mild corticosteroid to avoid the side effects of a stronger corticosteroid.
  • Vitamin A. Retinoids are a type of compound containing vitamin A. These compounds may help psoriasis by limiting the production of new skin cells, which psoriasis causes the body to overproduce. Retinoids also help reduce inflammation.
OTC topical treatments

Many different types of topical treatments are available over the counter. They’re designed to minimize symptoms rather than treat the condition itself. They’re often intended to soothe redness, soften lesions, or relieve itching.

Two of the most common active ingredients in OTC products are salicylic acid and coal tar. Other products might contain ingredients like:

  • aloe vera
  • jojoba
  • zinc pyrithione
  • capsaicin

You can find creams for psoriasis online. Other topical products like soaps, shampoos, and gels are also available.

If you’re a little overwhelmed by the large variety of OTC psoriasis products, you might want to look for the NPF Seal of Recognition to help you narrow down your choices.

Manufacturers of these products have submitted scientific data and test results substantiating a claim that their product was created or intended to be non- irritating and safe for people with psoriasis.

You can find an index of these products in the NPF online product directory.

Other medications

Other medications are used to treat severe or recurrent guttate psoriasis or for cases that have developed into plaque psoriasis. These medications require a doctor’s prescription and include:

  • Cyclosporine. Cyclosporine is an immunosuppressant. These drugs work by suppressing your immune system and lessening its mistaken attack on your skin cells. It’s typically used to treat severe psoriasis.
  • Biologics. Biologic drugs are made from substances in living things, like sugars, proteins, or nucleic acids. They suppress your immune system and increase your risk for infections. The several biologic drugs used to treat plaque psoriasis haven’t yet been sufficiently researched for guttate psoriasis. Currently, biologic therapy is used mostly in the 40 percent of guttate cases that develop into plaque psoriasis.
  • Methotrexate. This medication also suppresses the immune system. It’s typically used in severe cases or when other treatments don’t work.

Are there any natural treatments or home remedies for guttate psoriasis?

You may want to try natural treatments or lifestyle approaches to manage your guttate psoriasis. These may be especially helpful if you’re having your first outbreak or your symptoms are mild.

You might try natural treatments along with standard treatments or by themselves. Be sure to check with your doctor before beginning any new treatments.

Some natural treatments you may consider include:

  • Sunlight. Exposure to short periods of sunlight may help reduce your symptoms.
  • Bath salts. Soaking in a bath with Epsom or Dead Sea salts may help reduce inflammation and wash away dead skin cells.
  • Coconut oil. Coconut oil can soften the scales on your lesions and make it easier for topical medications to get to the skin below.
  • Vitamin D. Vitamin D may help reduce inflammation and improve the health of your skin. It’s usually applied topically.

Avoid using soaps and other personal care products that may irritate the skin. Soaps with added fragrances, dyes, or chemicals can be potential problems.

Healthy lifestyle approaches can sometimes help you manage your guttate psoriasis. These might include:

  • A nutritious diet. Eating nutritious food may diminish guttate psoriasis symptoms. But no diet can cure the condition. Be sure to talk with a medical professional before making any big changes in your diet.
  • Daily exercise. It’s important to keep up an exercise regimen when you have psoriasis, especially for your cardiovascular health. According to a 2020 study, there’s a link between psoriasis and an increased risk for cardiovascular disease.
  • Meditation or yoga. Meditation or yoga may help calm you down and reduce psoriasis symptoms, particularly itching. These practices may be especially helpful if stress is one of your psoriasis triggers.
  • Professional help. Research has shown that psoriasis can trigger feelings of shame and embarrassment, which can lead to anxiety and stress. If you’re having similar feelings, consider speaking with a mental health practitioner about your concerns.

What’s the long-term outlook for people with guttate psoriasis?

There’s no cure for guttate psoriasis, but most cases will clear up on their own within several weeks or months. Guttate psoriasis can also recur or develop into plaque psoriasis.

If an outbreak occurs, you’ll probably want to see a medical professional. That way, you’ll know for sure if you have guttate psoriasis and what the best treatment plan is.

A dermatologist will help you choose the form of therapy that best suits your condition and lifestyle. Follow your doctor’s treatment plan, and avoid psoriasis triggers when possible.

If you’re using topical treatments, including them in your post-shower routine is the easiest way to remember to use them. Water strips your body of its natural moisture. Applying ointments immediately after a shower can help lock in precious moisture.

Learning more about your condition can help you manage and treat your symptoms. Consider joining a psoriasis support group and speaking to others with your condition. The knowledge and tips you gain in dealing with your psoriasis can be invaluable.

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