What You Should Know About Living with Guttate Psoriasis
People often make the mistake of assuming all psoriasis looks the same—scaly and silvery. If you’ve experienced guttate psoriasis, however, you know that isn’t the case. While the most common type is plaque psoriasis, which is characterized by those scaly patches, about 8 percent of people with psoriasis develop guttate psoriasis. Guttate not only looks different but may be triggered for different reasons than other forms of psoriasis; it may need different treatment, too. Here’s what you should know.
What Is Guttate Psoriasis?
“Guttate psoriasis appears as small, red, scaly spots that resemble teardrops,” says Peterson Pierre, M.D., board-certified dermatologist at Pierre Skin Care Institute in Westlake Village, California. “They're not as thick as the spots you get from plaque psoriasis, and they tend to appear on the trunk and extremities but can also involve the face and scalp.”
These spots, called papules, tend to be pink or red in color and are raised and round, appearing in various sizes. The papules themselves are sometimes scaly but not always.
“Some may liken the appearance as similar to the pattern that might arise if someone used a brush to splatter paint drops on a wall by flinging the brush head,” describes Todd E. Schlesinger, M.D., board-certified dermatologist and medical director of Dermatology and Laser Center of Charleston in South Carolina.
How Does Guttate Psoriasis Develop?
Initial eruptions of guttate psoriasis tend to occur suddenly after an illness or other outside factor. “Guttate psoriasis usually appears in childhood or young adulthood and is often triggered by an infection such as strep throat or tonsillitis,” Pierre explains.
The National Psoriasis Foundation identifies these additional potential triggers for guttate psoriasis:
- Upper respiratory infections
- Injury to the skin
- Certain drugs, including antimalarials and beta-blockers
That initial flare-up usually lasts several weeks, Pierre says.
Because guttate psoriasis can be associated with other conditions, The National Psoriasis Foundation recommends getting checked out by a doctor if you develop this condition, as you may have an underlying infection.
Children and adults under the age of 30 are most often impacted by this form of psoriasis, and Schlesinger says it can affect people of all genders and races. “Genetic factors may play a role in predisposing one to this condition,” Schlesinger explains. “Rubbing or traumatizing the skin may produce new lesions in what is called the Koebner phenomenon.”
In the Koebner phenomenon, psoriasis plaques or pustules develop on our around where skin has been injured.
How Is Guttate Psoriasis Treated?
When first diagnosed with guttate psoriasis, Pierre says it’s important to determine if the condition was caused by an infection and, if yes, to have that infection treated if you still have it. You should also stop or replace medications that could have potentially triggered the condition, says Pierre. Often, treating the condition or ceasing the medication may be enough to end the guttate psoriasis outbreak.
“This form of psoriasis often resolves over weeks or months without treatment,” Schlesinger says.
Sometimes, the condition may persist or progress into a different form of psoriasis called plaque-type psoriasis.If the condition persists, standard psoriasis treatments can be used.
“The treatments for guttate psoriasis are similar to other forms of psoriasis," Pierre explains. These treatments may include:
- Cortisone creams, such as hydrocortisone, triamcinolone, or clobetasol, depending the location of the psoriasis
- Oral medications such as cyclosporine, methotrexate, or apremilast
- Injectable biologic medications
- Phototherapy treatment
As with other forms of psoriasis, there’s no one-size-fits-all treatment for guttate psoriasis. Treatments depend on a person's underlying medical history, as well as the risks and benefits of the treatment for each individual.
What Can I Expect in the Future?
While initial eruptions may disappear with or without treatment fairly quickly, once a person has been diagnosed with guttate psoriasis they may have additional flares in the future.
“Unfortunately, there is no cure,” says Pierre. “This can be a chronic intermittent disease for some, or it may show up later as plaque psoriasis.”
For this reason, you should seek medical care for any infections you have as quickly as possible, since “early intervention may prevent an acute flare of the disease,” says Schlesinger.
You should also stay aware of factors that seem to trigger your flares, so that you can try to avoid or reduce your exposure to them and lessen or prevent symptoms.
The important thing is that you regularly see a board-certified dermatologist you trust, and that you work closely with them to ensure you’re managing your condition effectively. “Guttate psoriasis isn't contagious and is usually very responsive to treatment,” Pierre says.
Editor's Note: This article has been updated to correct an error. An earlier version cited oral steroids as a treatment for guttate psoriasis. The article has been medically reviewed and updated to clarify that topical steroids are a treatment for guttate psoriasis.
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