Guttate psoriasis
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Guttate psoriasis is an acute, inflammatory form of psoriasis classified as an autoimmune skin disease. It most commonly occurs in children, adolescents, and young adults, often as the first episode of the disease. It is characterized by the sudden appearance of numerous small, drop-shaped skin lesions primarily distributed on the trunk and limbs. The disease has an immunological basis and is strongly associated with triggering factors, especially streptococcal infections of the upper respiratory tract. The course of guttate psoriasis can be self-limiting; however, in some patients, it serves as a starting point for the development of chronic plaque psoriasis, thus requiring proper diagnosis and dermatological monitoring.
Guttate psoriasis – causes
Guttate psoriasis develops due to an abnormal immune response, leading to excessive proliferation of keratinocytes and the formation of inflammatory changes in the skin. The activation of T lymphocytes and the secretion of pro-inflammatory cytokines play a key role.
The most important triggering factors include:
- Streptococcal infections of the throat and tonsils (particularly Streptococcus pyogenes) – the most common and well-documented cause,
- Genetic predisposition – the presence of psoriasis in first-degree relatives increases the risk of developing the condition,
- Acute viral infections (e.g., upper respiratory tract infections),
- Severe psychological stress – a factor that modulates the immune response,
- Skin injuries (Koebner phenomenon),
- Certain medications – including beta-blockers, lithium, interferons,
- Sudden hormonal changes and a decrease in immunity.
Unlike plaque psoriasis, guttate psoriasis often appears suddenly, usually 1–3 weeks after an infection, which is of significant diagnostic importance.
Guttate psoriasis – symptoms
The clinical picture of guttate psoriasis is characteristic and usually easy to recognize by an experienced dermatologist.
Typical symptoms include:
- Numerous small papules and spots with a diameter of 2–10 mm,
- Drop-like shape (hence the name of the disease),
- Pink or reddish color, often with mild scaling,
- Dispersed distribution of lesions, mainly on the trunk, upper and lower limbs, less commonly on the scalp,
- Skin itching – usually moderate, but can be severe.
The lesions usually do not form thick plaques as in plaque psoriasis and have a more uniform appearance. In some patients, the following may coexist:
- A feeling of skin tightness,
- Burning sensation,
- Sensitivity to external stimuli.
In laboratory tests, it is often found:
- Elevated ASO titer (antistreptolysin O),
- Features of a recent streptococcal infection.
Guttate psoriasis – treatment
The treatment of guttate psoriasis depends on the severity of the lesions, the extent of the affected skin, and the presence of triggering factors. Therapy should be conducted under the supervision of a dermatologist.
The basic therapeutic strategies include:
1. Causal treatment
- diagnosis and treatment of past or active streptococcal infection,
- in justified cases, implementation of antibacterial therapy after confirming the infection.
2. Topical treatment
- keratolytic agents to facilitate the removal of scales,
- anti-inflammatory agents to reduce erythema and infiltration,
- agents regulating epidermal proliferation,
- intensive emollient therapy to restore the skin barrier.
3. Phototherapy
- one of the most well-documented methods for treating guttate psoriasis,
- particularly effective in disseminated forms,
- leads to the suppression of the inflammatory response and normalization of the epidermal renewal cycle.
4. Systemic treatment
- considered only in severe, resistant cases,
- used short-term and under strict medical supervision.
In many cases, guttate psoriasis is transient and resolves within a few weeks or months. However, in some patients, it may lead to:
- recurrences of the disease,
- progression to chronic plaque psoriasis.
Therefore, it is crucial to:
- intervene early,
- eliminate provoking factors,
- have regular dermatological check-ups.
Treatments for guttate psoriasis
In the adjunctive treatment of guttate psoriasis, dermatological procedures with documented anti-inflammatory and immunomodulatory effects are playing an increasingly important role.
The most commonly used include:
- UVB 311 nm phototherapy
- inhibits excessive proliferation of keratinocytes,
- reduces inflammatory infiltration,
- shortens the duration of flare-ups,
- localized phototherapy (e.g., excimer light)
- allows precise irradiation of disease foci,
- limits exposure to healthy skin,
- procedures improving epidermal barrier function
- intensive regenerative therapies,
- procedures supporting the reconstruction of the hydrolipid layer,
- therapies alleviating itching and inflammation
- reduce patient discomfort,
- improve tolerance of primary treatment.
These procedures do not replace dermatological treatment but constitute an important complement to it, particularly in patients with extensive lesions, a tendency to relapse, or severe subjective symptoms.
Properly conducted therapy, based on the pathophysiological knowledge of the disease, allows in many cases to achieve long-term remission and reduce the risk of psoriasis progression in the future.
