Guttate Psoriasis | Atlas Dermato

General information

Acute variant of psoriasis characterized by the sudden eruption of numerous small, erythematous, scaly “drop-like” papules.
Most commonly occurs in children, adolescents, and young adults.
Frequently triggered by a streptococcal infection, particularly pharyngitis caused by group A Streptococcus pyogenes.
The eruption classically develops 1–3 weeks after an upper respiratory tract infection.
Other infections may also act as triggers.
May represent the first manifestation of psoriasis or occur in a patient with a personal or family history of psoriasis.
May resolve spontaneously within weeks to months, although some patients subsequently develop chronic plaque psoriasis.

Acute, rapidly disseminating eruption of numerous small lesions.
Frequently preceded by a recent sore throat or respiratory infection.
Lesions may be asymptomatic or associated with variable pruritus.
Individual lesions are considerably smaller and more numerous than typical plaque psoriasis lesions.
Recurrences may occur following subsequent streptococcal infections.

Multiple erythematous or salmon-pink papules, typically measuring a few millimeters to approximately 1 cm.
Well-demarcated, round or oval, “drop-like” lesions.
Covered by fine white or silvery scales, which may be subtle early in the eruption.
Numerous lesions may produce the appearance of a widespread exanthem.
Auspitz sign may occur: pinpoint bleeding after removal of scale, although this finding is neither required nor specific for the diagnosis.
Variable pruritus.

Regularly distributed dotted vessels on an erythematous background.
Diffuse white scaling.
Relatively uniform and symmetric vascular distribution.
These findings can help distinguish psoriasis from other papulosquamous disorders.

Primarily a clinical diagnosis based on characteristic morphology and distribution.
Assess for a recent streptococcal infection, particularly when pharyngeal symptoms are present.
Rapid antigen testing or throat culture if active streptococcal pharyngitis is suspected.
ASO or anti-DNase B titers may occasionally help document a recent streptococcal infection when clinically relevant.
Skin biopsy is rarely required but may be considered for an atypical presentation or diagnostic uncertainty.

Mild disease may resolve spontaneously and require primarily symptomatic treatment.
Emollients to reduce dryness and scaling.
Topical corticosteroids of appropriate potency may be used for symptomatic or inflammatory lesions.
Avoid prolonged application of superpotent topical corticosteroids over large body surface areas.
Widespread disease: narrowband UVB (NB-UVB/TL01) phototherapy is commonly preferred when phototherapy is indicated.
A confirmed active streptococcal infection should be treated according to standard recommendations for streptococcal pharyngitis.
Antibiotics are not an established treatment for the psoriatic eruption itself once an active streptococcal infection is no longer present.
Systemic psoriasis therapy is rarely necessary for an isolated episode but may be considered for persistent, severe disease or progression to chronic psoriasis.