Guttate Psoriasis: Symptoms, Causes, Treatment, and More

There are several different types of psoriasis, the autoimmune disease that causes raised, scaly patches of skin, or plaques, on a person’s skin. One variant of psoriasis, known as guttate psoriasis, is often misdiagnosed, especially in the children and young adults who most often have the condition.  

Here’s what you need to know about guttate (pronounced GUH-tate) psoriasis and how it’s diagnosed and treated. 

Symptoms 

Guttate psoriasis typically shows up as small, scaly patches of skin that are red or pink in color on light skin — people with darker skin may have violet or brown patches. These patches usually appear on the arms, legs, torso, or scalp, though they can appear anywhere on your body.  

The term “guttate” comes from the Latin word for teardrop, and the affected patches of skin are usually teardrop-shaped or round. They are often irritating or itchy, and have scales of dry skin that peel or flake off. 

Who Gets Guttate Psoriasis? 

Guttate psoriasis is a relatively rare skin disease: An estimated two percent of the world population is affected by psoriasis, and of these people, only about eight percent are estimated to have guttate psoriasis, according to the National Psoriasis Foundation. 

The disease most often shows up in children, though guttate psoriasis can also appear in teenagers and young adults. It’s rarely seen in adults over the age of 30, and it occurs equally in males and females. 

Causes and Triggers 

One thing that distinguishes guttate psoriasis from other types of psoriasis is the fact that it often shows up one to three weeks after a streptococcal infection: “In some individuals, a strep infection (commonly strep throat) can trigger an immune reaction within the body, which manifests as guttate psoriasis,” says Alexandra K. Golant, MD, FAAD, dermatologist and Medical Director, Faculty Practice, Mount Sinai Health System in New York. 

Other triggers associated with guttate psoriasis include:

• Different bacterial or viral infections (especially upper respiratory infections such as the flu or Covid-19)
• Tonsillitis
• Stress
• Skin injuries including cuts, insect bites, or sunburn
• Drinking alcohol
• The use of certain drugs such as antimalarials, lithium, or beta-blockers

There’s also a genetic component to the disease: People who have a family member — especially a parent — with any form of psoriasis are more likely to develop guttate psoriasis. 

Like other types of psoriasis, guttate psoriasis is not contagious and can’t be spread through skin-to-skin contact or sharing towels, bed linens or other materials. (However, strep infections, influenza, Covid-19, and other infections linked to guttate psoriasis are contagious and should be treated as soon as possible to avoid infecting others.) 

Diagnosis 

Your dermatologist or other health care provider can usually diagnosis guttate psoriasis through a physical examination and taking a brief medical history. In addition, they may take a throat culture to check for evidence of strep throat or other infection.  

A skin biopsy and blood tests can also be used to confirm guttate psoriasis, which can sometimes be confused for another condition such as an allergic reaction, ringworm (tinea corporis), syphilis, nummular eczema, or pityriasis rosea (sometimes called “Christmas tree rash”). 

Prognosis 

Guttate psoriasis doesn’t typically occur in stages — most often, the condition appears suddenly after an infection or other trigger.  

The good news is, it often quickly resolves on its own: “For over two-thirds of patients, guttate psoriasis will resolve spontaneously within three to four months,” says Golant. 

Moreover, the condition doesn’t always reappear (though that can happen with some people). If the outbreak was triggered by an infection of strep or other disease, that should of course be treated to help alleviate the guttate psoriasis.  

There is a risk, however, that someone with guttate psoriasis will eventually develop chronic psoriasis. “In about a quarter to a third of patients, guttate psoriasis does not resolve spontaneously and may persist as guttate psoriasis or plaque psoriasis,” says Golant.  

How Is Guttate Psoriasis Treated?

The first-line treatment for mild or moderate cases of guttate psoriasis is generally corticosteroid creams, shampoos or ointments that you can apply directly to the skin (topical). These may be over-the-counter or prescription-strength corticosteroids. 

There are also topical lotions containing coal tar and skin moisturizers that soothe the irritated skin that commonly occurs with the condition. Some cases of guttate psoriasis can be helped by using prescription medicines that contain vitamin A (retinoids) taken orally, or topical creams containing vitamin D. 

Phototherapy is sometimes suggested for moderate or severe cases: “Phototherapy is a very safe treatment and can be effective for some patients with guttate psoriasis,” says Golant. However, “phototherapy can pose practical challenges for some patients as it does require multiple in-office visits each week.” 

Also known as light therapy, with this treatment affected areas of the skin are exposed to carefully regulated ultraviolet (UV) light, alone or in combination with medication. Some doctors also recommend exposure to sunlight, provided it doesn’t cause sunburn.  

For recurring or severe cases of guttate psoriasis, your health care provider may prescribe drugs commonly used to treat chronic plaque psoriasis, such as methotrexate, apremilast (Otezla), or biologic medications. Biologics are drugs designed to target specific proteins in the immune system that contribute to skin outbreaks.  

Biologic drugs have been studied extensively for managing chronic plaque psoriasis, but less is known about their ability to safely treat guttate psoriasis. For that reason, the use of biologics often reserved for cases where guttate psoriasis progresses to plaque psoriasis.  

Powerful Podcasts to Help You Live Better with Psoriasis

The Global Healthy Living Foundation/CreakyJoints is embracing audio storytelling as part of our mission to reach the chronic disease patient community where they are. Click here to listen to one of our many podcasts, including Getting Clear on Psoriasis, The Psoriatic Arthritis Club, Breaking Down Biosimilars, The Health Advocates, Talking Head Pain, MatterofVax, Gut Culture, and more.