Guttate psoriasis is a distinctive form of psoriasis that looks like small, red drops scattered across the skin. Research shows it accounts for up to 25% of all psoriasis cases (1). While it can clear up within 3-4 months, about 39% of cases may develop into chronic plaque psoriasis.

What Is Guttate Psoriasis?

Guttate psoriasis gets its name from the Latin word “gutta,” meaning drop. This accurately describes how it looks. The condition creates small, red drops or spots scattered across the skin. Unlike the more common types of psoriasis that form thick, scaly patches, guttate psoriasis creates multiple small lesions.

The condition has unique features that make it different from other forms of psoriasis. It’s closely linked to genetic factors, immune system responses, and environmental triggers like stress and infections. It typically appears suddenly, often after a throat infection.

Note
Guttate psoriasis often appears 2-3 weeks after a streptococcal throat infection. If you develop small, drop-like red spots on your skin after having strep throat, see a dermatologist for proper diagnosis.

Who Gets Guttate Psoriasis?

Guttate psoriasis most commonly affects younger people. This includes children, teenagers, and young adults (2). This sets it apart from other forms of psoriasis that typically appear later in life.

Age

Studies involving patients with guttate psoriasis show a wide age range. For example, one study included participants aged 21 to 65 years. However, the condition most often first appears in younger individuals (2).

Genetic Factors

Recent research has identified specific genetic factors linked to guttate psoriasis. Scientists found that rare variants in the MED12L gene are associated with increased susceptibility to guttate psoriasis in the Chinese Han population (3). This discovery helps explain why some people are more likely to develop this condition.

What Causes Guttate Psoriasis?

The most important trigger for guttate psoriasis is streptococcal infection. This is particularly true for strep throat.

Guttate psoriasis has a well-established link to streptococcal infections. The condition characteristically occurs in children and young adults following streptococcal sore throat or tonsillitis (4).

However, not everyone with a positive strep test has an active infection that needs treatment. In one study of psoriasis patients, only 23 out of 162 participants had streptococcus-positive throat cultures (4).

How Strep Triggers Psoriasis

Research has shown how streptococcal infections can trigger psoriasis through the immune system. T cells are immune cells that respond to streptococcal proteins. These same cells can also react to similar proteins in the skin. This cross-reaction may explain why throat infections can lead to skin problems (5).

Symptoms and Appearance

Guttate psoriasis has a distinctive appearance that makes it recognizable to dermatologists.

What It Looks Like

The condition appears as scattered “drop-like” papules and plaques across the skin (1). These spots are typically:

  • Small (usually less than 1 cm in diameter)
  • Red or pink in color
  • Covered with fine scales
  • Numerous and widespread across the body

Body Areas Affected

In acute cases, guttate psoriasis can cover large areas of the body. Studies have included patients with anywhere from 10% to 90% of their body surface affected. The average coverage is about 26% (2).

The spots commonly appear on the trunk, arms, and legs. Unlike some other forms of psoriasis, guttate psoriasis less commonly affects the scalp, face, and nails.

Fact
The word “guttate” comes from the Latin word “gutta” meaning “drop.” This perfectly describes the drop-like appearance of the small, round psoriasis spots that characterize this condition.

Treatment Options for Guttate Psoriasis

Finding effective treatment for guttate psoriasis can be challenging. Research in this area is limited. A systematic review found only 5 randomized controlled trials among 75 total studies on guttate psoriasis treatment (1).

First-Line Treatments

The most recommended first-line treatments include topical corticosteroids and calcipotriol cream. These are often combined with phototherapy. For supportive therapy, antibiotics may be used if there’s an active streptococcal infection. This combination approach provides the best starting point for most patients.

Second-Line Options

When first-line treatments don’t work well enough, doctors may prescribe systemic medications. Methotrexate or cyclosporine are the most commonly recommended second-line treatments for guttate psoriasis that doesn’t respond to initial therapy.

Third-Line Treatments

For severe cases that don’t respond to other treatments, biologic medications can be considered. However, these are typically reserved for the most challenging cases. This is due to their cost and the limited research specifically on guttate psoriasis.

Do Antibiotics Help Guttate Psoriasis?

Since streptococcal infections often trigger guttate psoriasis, it seems logical that antibiotics might help. However, research shows a different story.

Multiple studies have tested whether antibiotics improve guttate psoriasis, with disappointing results. A controlled study of 43 patients found no significant improvement in those treated with penicillin or erythromycin. This was compared to those who received no treatment (6).

Another study tested whether adding rifampin to standard antibiotics would help. Twenty patients received either antibiotics plus rifampin or antibiotics plus placebo. Despite meeting all criteria for streptococcus-associated psoriasis, none of the patients showed improvement (7).

A comprehensive Cochrane review concluded there’s no firm evidence supporting antibiotics for managing established guttate psoriasis. This is despite the known association with streptococcal infection (8).

Does Tonsillectomy Help Treat Guttate Psoriasis?

Since throat infections trigger guttate psoriasis, researchers have studied whether removing the tonsils helps prevent flare-ups.

The results for tonsillectomy are more promising than for antibiotics. A review of 410 psoriasis patients who underwent tonsillectomy found that 290 (71%) experienced improvement in their psoriasis (9).

A prospective study showed even better results. Among 15 patients who had tonsillectomy, 13 (86%) showed sustained improvement. This improvement ranged from 30% to 90% reduction in disease severity. The improvement correlated with a decrease in skin-reactive T cells in their blood (5).

Who Might Benefit

A recent systematic review found that tonsillectomy showed positive outcomes for patients with guttate and chronic plaque psoriasis, indicating improved symptoms and quality of life (10).

Warning
Tonsillectomy is surgery with potential risks. It should only be considered for carefully selected patients with recurrent strep throat and psoriasis flares. Not all patients maintain improvement after the procedure.

Topical Treatments

Topical medications applied directly to the skin are often the first treatment tried for guttate psoriasis.

Evidence for Effectiveness

Research specifically on topical treatments for guttate psoriasis is limited. However, a systematic review identified topical corticosteroids and calcipotriol as having the most evidence for effectiveness. Calcipotriol is a vitamin D derivative (1).

These medications work by:

  • Reducing inflammation (corticosteroids)
  • Slowing down rapid skin cell growth (calcipotriol)
  • Helping remove scales and smooth the skin

Phototherapy

Light therapy is one of the most effective treatments for guttate psoriasis. It has the strongest evidence base.

How Well Does It Work?

Narrowband UVB phototherapy has the most robust evidence for treating guttate psoriasis. This treatment uses a specific wavelength of ultraviolet light that’s particularly effective for psoriasis (1).

Treatment typically involves:

  • Sessions 2-3 times per week
  • Gradual increase in light exposure
  • Treatment continuing until skin clears

Systemic Medications

When topical treatments and phototherapy aren’t enough, doctors may prescribe medications that work throughout the body.

Traditional Options

For second-line treatment, the systematic review recommends methotrexate or cyclosporine. These medications suppress the overactive immune response that causes psoriasis (1).

Biologic Medications

For severe cases that don’t respond to other treatments, biologics can be considered as third-line therapy. However, most research on biologics has focused on chronic plaque psoriasis. There’s less research specifically on guttate psoriasis.

Tip
If you’re prescribed systemic medications for guttate psoriasis, regular blood tests may be needed to monitor for side effects. Always follow your doctor’s instructions and report any concerning symptoms promptly.

Alternative Treatments

Some alternative treatments have been studied for guttate psoriasis. However, evidence is limited.

Fish Oil Treatment

One study tested intravenous fish oil against soy oil in 21 hospitalized patients with acute guttate psoriasis. The fish oil contained n-3 fatty acids. The fish oil group showed remarkable improvement. They improved between 45% and 76% in all measures within 10 days. The soy oil group only improved 16-25% (11).

However, this treatment used intravenous infusions in a hospital setting. It didn’t use oral supplements. More research is needed to determine if oral supplements might provide similar benefits.

Natural Course and Outcomes

Understanding what to expect with guttate psoriasis can help patients and families plan treatment.

The good news is that guttate psoriasis often clears on its own within 3 to 4 months (1). This spontaneous clearing is more common with guttate psoriasis than with other forms of the disease.

While many cases clear completely, about 39% of people with guttate psoriasis may develop chronic plaque psoriasis (1). This means the condition changes from small, scattered drops to larger, thicker patches that persist long-term.

When to See a Doctor

You should see a dermatologist if you develop small, red, drop-like spots on your skin. This is especially important if:

  • You recently had strep throat or another infection
  • The spots are spreading or getting worse
  • You have itching or discomfort
  • Over-the-counter treatments aren’t helping
  • You’re concerned about your appearance

Early treatment may help clear the condition faster. It may also potentially reduce the risk of developing chronic psoriasis.

Conclusion

Guttate psoriasis is a unique form of psoriasis that primarily affects children and young adults. While it’s strongly linked to streptococcal infections, antibiotics haven’t proven effective for treating established cases. The condition often clears within a few months, but about 39% of patients may develop chronic psoriasis.

Current evidence supports a stepwise treatment approach. This starts with topical medications and phototherapy. For those who don’t respond, systemic medications are available. Tonsillectomy may help selected patients with recurrent strep-triggered flares.

More research is needed specifically on guttate psoriasis treatments. Many current recommendations are based on limited evidence or studies that included various psoriasis types. If you or your child develops guttate psoriasis, work closely with a dermatologist. They can find the most appropriate treatment plan for your specific situation.

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