Guttate Psoriasis: What is it?

Guttate psoriasis is a form of psoriasis characterized by thin plaques and minimal scaling that form on the torso, back, and limbs. It typically occurs in children and young adults. It can occur alone (acute guttate psoriasis) or exacerbate an existing chronic plaque psoriasis, often quite limited (outbreak of chronic plaque psoriasis in drops). These plaques spread rapidly over the entire body when they measure less than one centimeter. The hair and nails are spared in most cases.

The droplets formed by guttate psoriasis can cause itching in the patient. After the plaques disappear, the red lesions heal quickly.

Several factors can be at the root of guttate psoriasis:

• Bacterial Infection: Streptococcus : A sore throat that occurred a few weeks prior can lead to the emergence of this skin rash. Streptococcus is the triggering factor for this type of condition. A virus can also be a triggering agent for this skin problem.

• Reaction to anti-INF or post-vaccination: Anti-INF are biomedicines proposed for the treatment of moderate to severe forms of psoriasis. They can lead to the onset of mild guttate psoriasis in cases of unexpected reactions. A few exceptional cases of this skin disease occur after vaccination.

• Genetic Heritage: just like other forms of psoriasis, guttate psoriasis can also have a genetic origin.

Mild guttate psoriasis progresses differently from one patient to another. The plaques can last a month and disappear, without treatment, after two to three months. Patients are divided into three categories:

• Category 1: This includes those who experience a single flare-up.

• Category 2 : This pertains to patients with mild guttate psoriasis that progresses into plaque psoriasis, but they do not experience a remission phase.

• Category 3 : this includes patients going through a period of remission (of varying lengths) before the growth of plaque psoriasis.

Generally, the patches stay for about a month and then naturally disappear within 2 to 3 months. However, in some cases, treatment may be necessary.

The treatment of guttate psoriasis is determined based on the causes of the disease. It can be treated with antibiotics prescribed for the management of ENT (Ear, Nose, and Throat) conditions. These medications are used when the infection is caused by streptococcus bacteria.

The local treatment of guttate psoriasis is also a viable option to combat this disease. To treat the affected area, the use of medications, prescribed by a doctor, based on dermocorticoids in combination or not with calcipotriol betamethasone may be sufficient.

When topical medications fail to effectively treat guttate psoriasis, phototherapy can be utilized as an alternative. This approach is suitable for managing widespread and persistent psoriasis. Systemic medication may be prescribed by a doctor in cases of severe flare-ups.

TELFER N. R. & al. The Role of Streptococcal Infection in the Initiation of Guttate Psoriasis. Archives of Dermatology (1992).

TELFER N. R. & al. CHALMERS R. J. G. & al. A systematic review of treatments for guttate psoriasis. British Journal of Dermatology (2001).

BENETON N. Le psoriasis en gouttes. Association France Psoriasis (2023).