Guttate psoriasis is a variant of psoriasis that is characterized by an acute, generalized eruption of small, discrete, raindrop-like (hence the name, guttate) papules with fine scale. It most commonly occurs in the 2-3 weeks following an upper respiratory infection and is associated with an elevated anti-streptolysin O, anti-DNase B, or streptozyme titer. Guttate psoriasis can be pruritic, and postinflammatory pigmentary changes can follow. However, scarring and systemic symptoms such as fever, malaise, lymphadenopathy, myalgias, and arthralgias are typically not present.
While guttate psoriasis may occur in any age group, it is most common in children and young adults under the age of 30. The prognosis in children is typically better than in adults, with many children spontaneously clearing within several weeks to months. Nevertheless, some patients will go on to develop chronic psoriatic disease several years later.
Guttate psoriasis in Child
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Synopsis
Codes
ICD10CM:
L40.4 – Guttate psoriasis
SNOMEDCT:
37042000 – Guttate psoriasis
L40.4 – Guttate psoriasis
SNOMEDCT:
37042000 – Guttate psoriasis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Nummular dermatitis – Intensely pruritic, coin-shaped lesions almost exclusively seen on the extremities.
- Tinea corporis – Usually fewer isolated lesions. Check potassium hydroxide (KOH) prep.
- Tinea versicolor – Less scale and less inflammatory. KOH-positive.
- Pityriasis rosea – Look for a herald patch, collarette of scale, and orientation of lesions (fir-tree pattern in skin tension lines).
- Small plaque parapsoriasis – More common in older adults; chronic asymptomatic patches.
- Pityriasis lichenoides chronica – Biopsy will assist in differentiating from guttate psoriasis, predominantly CD8+ T-cell infiltrate.
- Lymphomatoid papulosis – Biopsy will assist in differentiating from guttate psoriasis, predominantly CD30+ T-cell infiltrate. Generally presents as recurrent crops of papules. Uncommon in children.
- Psoriasiform drug eruption – Ask about medication history.
- Viral exanthem – Usually less scaly.
- Chronic papular atopic dermatitis
- Pityriasis lichenoides et varioliformis acuta (PLEVA) presents with recurrent crops of crusted, vesicular, or pustular lesions.
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References
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Last Reviewed:05/18/2017
Last Updated:05/18/2017
Last Updated:05/18/2017
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Guttate psoriasis in Child