Get rid guttate psoriasis

Guttate Psoriasis: What You Need to Know

The red spots in guttate psoriasis can look like droplets.iStock.com

Lots of people ask Carol Shurlow whether she has poison ivy. She’s no longer surprised by the question. Shurlow, 53, of Columbus, Ohio, has been living with guttate psoriasis since she was 15. “It’s pretty much present all the time,” she says.

Unlike plaque psoriasis, which is characterized by raised red lesions and affects 80 percent of people with psoriasis, guttate psoriasis looks like tiny red spots, but with the same characteristic scale.

While only about 10 percent of patients with psoriasis have the guttate type, guttate is the second most common type of the autoimmune disease. Its risk factors and the ages of the people it affects are very different from other forms.

What Causes Guttate Psoriasis?

The term “guttate” comes from the Latin word “gutta,” meaning drop; the red spots in guttate psoriasis can look like droplets.

Very often, guttate psoriasis comes on suddenly. Strep throat is a common trigger, says Jeffrey Sugarman, MD, PhD, an associate clinical professor in the departments of dermatology and family medicine at the University of California in San Francisco, and a medical director at Redwood Family Dermatology in Santa Rosa.

The environment seems to play a more important role in guttate psoriasis than in other types of the disease.

Guttate psoriasis can also be triggered by:

  • An upper respiratory infection
  • Tonsillitis
  • Stress
  • An injury to the skin such as a burn, cut, or scrape
  • Some medications such as beta-blockers, which are used to treat heart conditions, and drugs that treat malaria

These triggers can unmask psoriasis in people who may have a family history or other risk factor for the disease.

Shurlow doesn’t know what triggered her guttate psoriasis. She can’t recall anything in particular, but she was sick a lot as a kid. “I had asthma, and from when I was 4 until about 10, I got bronchitis a lot,” she recalls.

Shurlow does know that when she’s under stress, her guttate psoriasis symptoms can be worse. Also, two or three days before she has any symptoms of a cold or other illness, she’ll notice more spots. “I find it kind of strange,” she says. “It’s like a warning sign that I’m going to get sick.”

How Is Guttate Psoriasis Diagnosed?

Dermatologists diagnose guttate psoriasis much as they do plaque psoriasis: mostly from the distinct appearance of the rash, says Dr. Sugarman.

As with plaque psoriasis, guttate psoriasis appears most often on the trunk and limbs, says Sugarman. But instead of the thick red lesions you get from plaque psoriasis, you get tiny red spots — “and it can be hundreds,” he adds.

As part of the diagnosis, your doctor will also ask whether you’ve had strep throat or another infection, and may do a skin biopsy and a throat culture to confirm the diagnosis — though this isn’t often necessary. Your doctor may also ask whether you’ve been taking any new medications or supplements.

Most people get guttate psoriasis as children or young adults. In older adults, it can often be the initial presentation of the more chronic plaque psoriasis, and it often runs in families. But Shurlow says that in her family, only a cousin is also living with guttate psoriasis.

Guttate psoriasis’s teardrop-shaped rash can break out almost anywhere on your body. The red spots can be covered with silver, flaky scales, similar to plaque psoriasis.

Guttate psoriasis may go away on its own in a few weeks or months. If it doesn’t, it can be treated with topical medications, although applying creams and ointments to the hundreds of tiny drops on your skin can be tedious. “I’ve done numerous steroid creams over the years,” Shurlow says. Dandruff shampoos and moisturizers may help, too.

Phototherapy is often an effective treatment for guttate psoriasis. “Light therapy helped a lot,” says Shurlow.

If you have a severe case, your doctor might prescribe oral or injectable medications to dampen your inflammatory response. Shurlow has been on a biologic for about five years, and it’s helped clear her skin. “I feel very fortunate that insurance has covered most of the cost,” she says. “I still have a copay, but it’s reasonable.”

Can There Be Complications from Guttate Psoriasis?

As with any type of psoriasis, guttate psoriasis may lead to complications.

“Some people can have one episode of guttate psoriasis when they are 12 years old and never have it again,” Sugarman says. “Others wind up with chronic psoriasis and some lipid abnormalities: high blood cholesterol and triglycerides.”

It’s also possible to develop the more common plaque psoriasis.

Guttate psoriasis can cause severe itching and, less frequently, serious skin infections. About 10 percent of people living with guttate psoriasis develop psoriatic arthritis, which causes chronic joint inflammation.

Work closely with your doctor to find the best treatment for you, and the condition will be easier to manage.

While psoriasis and psoriatic arthritis are chronic autoimmune conditions, there are certain lifestyle modifications that can reduce the likelihood for flare-ups.

Here I discuss how psoriasis and psoriatic arthritis are related, the risk factors that contribute to disease, and various treatment options.

What is Psoriasis?

Psoriasis is an autoimmune skin disorder characterized by red patches covered with thick silvery scales. The most common form of psoriasis is plaque psoriasis, with lesions most commonly found on elbows, knees and scalp. Other forms of psoriasis include guttate psoriasis, pustular psoriasis and inverse psoriasis.

What is Psoriatic Arthritis? How is it linked to Psoriasis?

Psoriatic arthritis is an autoimmune disorder characterized by inflammation of the joints, and occasionally the spine. Patients with psoriatic arthritis typically present with joint pain, swelling and prolonged AM stiffness. Patients may also have inflammatory low back pain, which improves, rather than worsens, with activity. This is different from mechanical low back pain, which worsens with activity. Enthesopathy, or inflammation at the sites where tendons and ligaments attach to the bone, is another key feature of psoriatic arthritis. Achilles tendonitis and plantar fasciitis are examples of enthesopathy. Dactylitis (“sausage digit”), nail changes, and eye inflammation are also associated with psoriatic arthritis.

What is the likelihood of a patient developing psoriatic arthritis? What are the risk factors?

Psoriatic arthritis affects up to 25 percent of patients with psoriasis, although the incidence has been estimated to be higher (around 20–40 percent) in patients with more extensive skin disease. The majority of patients have psoriasis at the onset of their arthritic symptoms, but some may develop skin disease well after the arthritis has presented. Some patients with psoriatic arthritis may never develop psoriasis, but they may have a family history of psoriasis or psoriatic arthritis. Obesity during early adulthood and HIV have also been identified as risk factors. In patients with psoriasis, the severity of psoriasis, the presence of nail pitting and uveitis have been correlated with an increased risk developing psoriatic arthritis.

What are the current treatment options for patients who suffer from both conditions?
Methotrexate is a traditional disease modifying agent that is effective in both psoriasis and psoriatic arthritis. Patients with severe psoriasis and/or psoriatic arthritis are often treated with biologic agents, such as anti-tumor necrosis factor inhibitors , ustekinumab, and secukinumab. There are newer oral medications such as apremilast and tofacitinib that have both been approved for psoriatic arthritis, but tofacitinib has not yet received FDA approval for plaque psoriasis.

Are there any lifestyle modifications that I can make?

Absolutely. Several lifestyle modifications have been shown to be beneficial in psoriasis and psoriatic arthritis patients, including weight loss, routine exercise, and avoidance of smoking and excessive ETOH consumption.

Dr. Dee Dee Wu is a rheumatologist who specializes in the treatment of rheumatoid arthritis, psoriatic arthritis, osteoarthritis and osteoporosis. She practices at both the HSS Outpatient Center in Paramus and the hospital’s main campus in New York.

Treatments for acute guttate psoriasis, excluding drugs aimed at treating infection caused by Streptococcus bacteria

Review question

The aim of this review was to find out how well different non-antistreptococcal treatments (i.e. drugs not aimed at eradicating streptococcal infection) work for treating acute guttate psoriasis or an acute guttate flare of chronic psoriasis in adults and children, and how safe they are when compared against placebo (an identical but inactive treatment) or another treatment. This was important because there is a lack of information and evidence about the best way to treat guttate psoriasis. We collected and analysed all relevant studies to answer this question and found one study.

Background

Psoriasis is a chronic skin disease characterised by patches of red, flaky skin covered with scales (known as plaques). Approximately 2% of people have psoriasis. Guttate psoriasis is a type of psoriasis that is characterised by smaller lesions and is more common in children and young people. Treatments for guttate psoriasis aim to clear the skin of lesions for as long as possible, and include topical (applied to the skin) or oral (taken by mouth) medicines; phototherapy (i.e. ultraviolet light therapy); and biological medicines (whereby a living organism creates the active substance). It is not known which of these treatments work best at clearing lesions in guttate psoriasis and whether they are safe.

Study characteristics

We found one relevant study that compared the effects of giving injections into the vein of two different lipid (fat) emulsions twice daily for 10 days: one emulsion (two or more liquids that are often unmixable) was derived from fish oil, and the other was derived from soya oil. Participants were followed for a total of 40 days. The study was conducted in Germany in 21 adults (18 men and 3 women) aged 21 to 65 years, with a mean of involved skin surface of 25%, who were in hospital with acute guttate psoriasis. The study was funded by the company that produces the oil emulsions.

Key results

Treatments for which we found no evidence include phototherapy and topical, oral, and biological medicines. The only study identified did not measure our two primary outcomes: percentage of people treated whose skin became clear (or almost clear) of lesions; and the side effects, or harms, of the treatments.

Most of our secondary outcomes were also not measured, including worsening of guttate psoriasis or recurrence within a period of six months after the treatment has finished; and percentage of participants achieving a Psoriasis Area Severity Index 75 or Physician’s Global Assessment of 1 or 2. The included study did not report measuring any harms of the treatments; however, the study authors did report rare skin irritation at site of injection, but did not provide the number of affected participants.

The study participants rated some outcomes themselves, including the appearance of the skin lesions, the effects on their daily life, itching, burning, and pain. After 10 days of treatment, study participants who received the fish oil-derived lipid emulsion (75% of people in this group) rated greater improvements than those receiving the soya oil-derived lipid emulsion (18% of people in this group). However, these results are uncertain as they are based on very low-quality evidence.

The evidence is current to June 2018.

Quality of the evidence

We rated the quality of the available evidence as very low.

We considered that the study may be at risk of bias due to limitations in its design, and only a small number of people were included in the study. In addition, the study only enrolled adults, although guttate psoriasis is more common in children.

Psoriasis: More than skin deep

Updated: June 20, 2019Published: July, 2010

The first accurate medical discussion of psoriasis dates back to 1801, but the disease itself is much older. In fact, its very name is borrowed from an ancient Greek word meaning an itchy or scaly condition. About 7 million Americans are plagued by this itching and scaling, and many of them have serious complications involving other organs. Although psoriasis is classified as a dermatologic disease, it doesn’t start in the skin, and its damage may be more than skin deep.

Beneath it all

At a basic level, psoriasis is a disorder of the immune system. White blood cells called T-helper lymphocytes become overactive, producing excess amounts of cytokines, such as tumor necrosis factor, interleukin-2, and interferon-gamma. In turn, these chemicals trigger inflammation in the skin and other organs. In the skin, the inflammation produces three characteristic findings: widened blood vessels, accumulation of white blood cells, and abnormally rapid multiplication of keratinocytes, the main cells in the outer layer of the skin. In healthy skin, keratinocytes take about a month to divide, mature, migrate to the skin surface, and slough off to make way for younger cells. But in psoriasis, the entire process is speeded up to as little as three to five days. The result is thickened, red skin that sheds silvery scales of keratinocytes that have matured before their time (see Figure 1).

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What is Guttate Psoriasis?

About 8 million Americans have psoriasis in some form. That’s about 2 to 3 percent of the nation’s population, making it one of the most common skin conditions in the country, but it affects much more than the skin. It can have a serious impact on your overall health and quality of life. Psoriasis comes in a variety of forms, including guttate psoriasis. Read on to learn more about guttate psoriasis and potential treatment options.

Psoriasis and Guttate Psoriasis

Although psoriasis is most characterized by its effects on the skin, it is actually an immune-mediated disorder. The immune system mistakenly attacks healthy skin cells while also signaling for the production of new skin cells. This results in a speed up in skin cells’ natural lifecycle, causing layers of skin cells to rapidly grow in layers on top each other. This leads to the main characteristic of most forms of psoriasis: the appearance of plaques, which are patches of dry, scaling skin that may be itchy, red, and inflamed.

Guttate psoriasis is a particular form of psoriasis that mainly affects children and young adults. It is the second most common form of psoriasis next to plaque psoriasis. About 10 percent of all people with psoriasis are estimated to develop guttate psoriasis. Similar to other forms of psoriasis, guttate can appear in cycles where the skin will flare up for weeks or months before subsiding or even going into remission.

Symptoms of Guttate Psoriasis

The main symptom of guttate psoriasis is the lesions characteristic of other forms of psoriasis. However, guttate lesions tend to be smaller than those of plaque psoriasis. Guttate lesions appear as red, separated dots that can number in the hundreds. These can appear just about anywhere on the skin, but they are most common on the trunk and limbs. They may sometimes appear on the ears, face, and scalp. Lesions are usually covered in a fine scale, but they are not as thick as lesions that form from plaque psoriasis.

Guttate psoriasis can also coexist with other forms of psoriasis. Guttate can also come as a single outbreak that goes away on its own, or you may have repeated episodes.

Guttate Psoriasis Causes and Triggers

Psoriasis is caused by a malfunctioning immune system, but what actually causes guttate psoriasis and the immune system to attack healthy skin cells still is not known. Research does suggest that psoriasis is linked to genetics. If one of your parents has psoriasis, you have a 10 percent chance of developing psoriasis. If both parents have psoriasis, that chance jumps to 50 percent.

It’s understood that psoriasis flare ups can be caused by specific triggers. These triggers can vary from person to person, but guttate psoriasis has a specific, well-known trigger: bacterial infections. Specifically, strep throat is known to trigger an immune system reaction that may result in a guttate psoriasis flare up.

Other common triggers for guttate psoriasis include:

  • General upper respiratory infections
  • Tonsillitis
  • Stress
  • Physical injuries to the skin
  • Antimalarials, beta blockers, and other prescription drugs

Guttate Psoriasis Treatment

Most outbreaks of guttate psoriasis will last around two to three weeks before going away on their own. However, based on your own discomfort and the potential presence of an underlying strep infection, your doctor will likely want to treat symptoms.

Topical treatments tend to be the preferred mode of treatment for guttate psoriasis. These can include:

  • Lotions or creams containing coal tar
  • Cortisone cream to control swelling and itching
  • General moisturizers

However, applying topical creams to numerous small lesions can be tedious. For more moderate forms of guttate psoriasis, your doctor may suggest phototherapy, which involves exposing your skin to controlled amounts of ultraviolet light for set periods of time. The UV light can help to slow down the growth of excess skin cells. Your doctor may also prescribe the use of systemic medication, which refers to drugs that are either injected or orally administered. A short course of systemic drugs can quickly clear up guttate psoriasis for long periods of time. However, most systemics also come with side effects, which is why these medications should only be used for short periods and only for severe cases that are unresponsive to other forms of treatment.

You deserve to take control of your own skin. Consult your doctor if you think you may have guttate psoriasis to receive treatment.

Sources:

Guttate psoriasis is a common skin condition

Courtesy American Academy of DermatologyThis type of psoriasis shows up on the torso and limbs and appears as small red spots that look like water drops on the skin. About 10 percent of the people who develop psoriasis develop guttate psoriasis.

It often comes hand in hand with other illnesses

“Guttate psoriasis can commonly be linked to upper respiratory infections (URI), particularly streptococcal (strep) infections,” says Mohiba Tareen, MD, a dermatologist at Tareen Dermatology. “Sixty-six percent of those with an acute guttate psoriasis flare had a clear history of a recent severe URI. The science shows that strep infections can activate immune cells called T lymphocytes that then ‘turn on’ psoriasis in genetically predisposed individuals.” Generally, the rash appears a few weeks after the illness that caused it subsides. Even so, you should learn these strep symptoms so you don’t avoid a URI diagnosis and delay treatment.

Stress—or simple skin injuries—can also cause a flare-up

“Stress, injury to the skin, sunburn, and rarely, medications may precipitate an attack of guttate psoriasis on susceptible individuals,” says Melanie Palm, MD, board-certified dermatologist and cosmetic surgeon from Art of Skin MD, in San Diego. For quick relief, try these all-natural psoriasis remedies you can make at home.

It can become a chronic issue

“For many cases of guttate psoriasis related to an infection, especially strep, it is likely to clear once the strep has been effectively treated,” says Dr. Palm. “Oftentimes, the guttate psoriasis does not return.” People under 30 years old are most likely to develop guttate psoriasis, according to the Mayo Clinic. However, your age may be a factor in whether it is cured or becomes a chronic condition. Dr. Tareen explains that children with guttate psoriasis may be in remission over a matter of months or even weeks. Unfortunately, the prognosis isn’t as promising for adults. The condition could become chronic or flare up with subsequent strep or viral infections.

It can turn into plaque psoriasis

Some people with guttate psoriasis have a hard time staying in remission, and it can develop into plaque psoriasis. A small study published in 2016 in the journal Cutis found that people with guttate psoriasis have a one in four chance of developing plaque psoriasis. An older study in The Journal of Dermatology suggests family history may also play a role in the progression. While that is a frightening fact, at least you can check out these promising new psoriasis treatments.

Medications can help

funnyangel/“Treatment of guttate psoriasis may include topical steroids, calcipotriene, or calcineurin inhibitors,” says Dr. Palm. “In severe cases, light therapy, or systemic medications may be required.”

Lifestyle changes can help reduce recurrence

“Lingering infections, stress, physical injury—a phenomenon called Koebner reaction—alcohol use, and excessive weight may worsen psoriasis,” Dr. Palm says. Improving your overall health can help reduce the risk of a flareup. The American Academy of Dermatology recommends a variety of lifestyle changes, such as quitting smoking, limiting alcohol, maintaining a healthy weight, getting screened for related diseases, exercising, and eating a healthy diet. Take precautions by avoiding these foods that could make your psoriasis worse.

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