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Guttate psoriasis

Published by Bupa's health information team, August 2008.

This factsheet is for people who have guttate psoriasis, or who would like information about it.

Psoriasis is a common skin condition causing patches of inflamed skin. Guttate psoriasis is one form of the condition in which small, circular, inflamed patches of skin suddenly appear all over the body, usually after a throat infection.

About guttate psoriasis
Symptoms of guttate psoriasis
Complications of guttate psoriasis
Causes of guttate psoriasis
Diagnosis of guttate psoriasis
Treatment of guttate psoriasis
Further information
Questions and answers
Related topics
Sources

About guttate psoriasis

In psoriasis, the rate at which your skin is replaced is rapidly increased.

Your skin is constantly shedding old cells and being replaced with new ones from underneath, in a cycle that usually takes about 28 days. In psoriasis, this process speeds up, only taking about three to four days. New skin cells move rapidly to the surface before they have properly matured, and accumulate on the surface of the skin, forming thick patches called plaques. There is also a build-up of a type of white blood cell (called T-cells) under the skin, which causes inflammation.

In guttate psoriasis, the condition appears suddenly, usually about a week after an infection. It tends to affect children, adolescents and young adults. People who have other types of psoriasis may also get this form.

Symptoms of guttate psoriasis

Guttate psoriasis is sometimes known as teardrop psoriasis or raindrop psoriasis, due to the shape of the plaques. The plaques are usually small (up to 1cm in diameter) and quite widespread. They can develop anywhere on your body, except the palms of your hands and the soles of your feet.

You may also notice changes in your nails, such as:

irregular pitting (the surface of the nail is covered in small pin pricks)
areas of discolouration
your nail coming away from the underlying nail bed

If you think you have any of these symptoms, you should see your GP.

Complications of guttate psoriasis

Guttate psoriasis may go away by itself within a month to two months. However, in many people, it recurs (keeps coming back). In addition, it may develop into another form of psoriasis (see related topics).

Up to 10 percent of people with psoriasis also develop associated arthritis (inflamed joints). This is called psoriatic arthritis. Usually the joints at the end of the fingers and toes are affected, although the back, knees and hips may be too. For more information on psoriatic arthritis, please see related topics.

Causes of guttate psoriasis

It is thought that substances produced by your immune system cause your skin to start producing new cells faster in psoriasis, as well as causing the build-up of T-cells.

Guttate psoriasis tends to develop after an infection - often a throat infection with a type of bacteria called Streptococcus. In guttate psoriasis, it is thought that this bacteria triggers the changes in your immune system and the onset of psoriasis.

Diagnosis of guttate psoriasis

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Usually, your GP will be able to tell whether you have psoriasis just by looking at your plaques. He or she will assess the extent of your psoriasis and how severe it is.

If you had a sore throat before your psoriasis started, your doctor may take a swab from your throat to confirm whether you have been infected with Streptococcus bacteria.

Your GP may refer you to a dermatologist - a doctor specialising in conditions affecting the skin, if you need specialist treatment or if your psoriasis is very widespread (covers a large part of your body).

Treatment of guttate psoriasis

Guttate psoriasis usually goes away on its own, but treatment can help to get rid of your symptoms quicker. Your GP will discuss your treatment options with you.

Self-help

Your GP will probably advise you to use emollients. He or she will usually prescribe these, but you can also buy these products from a shop without a prescription. They are very effective at keeping your skin moist, softening scaling and reducing irritation. It's worth discussing the choice of treatment with your doctor so that you can get the best results.

Topical therapies

Your GP can also prescribe you a medicated topical preparation (a treatment that is applied directly to your skin, such as a cream or ointment). Topical treatments for guttate psoriasis include creams and ointments containing:

coal tar - these can reduce inflammation; however, they can be messy
steroids
vitamin D derivatives (such as calcitriol or tacalcitol) - these can be easier to use than some products, but can sometimes irritate the skin

Medicines

Sometimes, your GP may prescribe you an antibiotic if your psoriasis was triggered by a throat infection. However, it hasn't been proven that antibiotics will help to get rid of guttate psoriasis or to prevent it, so doctors don't always give this treatment.

Light therapy

Light therapy can only be given by a dermatologist and is used if your psoriasis is widespread (covers a large part of your body) or if it doesn't respond to the above treatments. You may be offered the following light therapies.

Ultraviolet B (UVB) light therapy - this is the most common type of light therapy used for guttate psoriasis. UVB light occurs naturally in sunlight. This therapy involves shining artificial UVB light onto your skin. You will usually have the therapy two to three times a week for several weeks.
Psoralen and ultraviolet A light treatment (also called PUVA) may also be used for guttate psoriasis. This involves combining a medicine which sensitises the skin to sunlight (psoralen) with a controlled dose of ultraviolet A (UVA) light. You may have psoralen as a tablet or applied directly to your skin. The UVA light is given in a machine that looks similar to a shower cabinet, containing fluorescent tubes. You usually have the treatment twice a week, for several weeks.

Light therapy is particularly useful for guttate psoriasis, as there are often numerous scattered patches of tiny spots, which can be difficult to treat with creams and ointments.

Further information

The Psoriasis Association
0845 676 0076
www.psoriasis-association.org.uk