Guttate psoriasis in Child
Alerts and Notices
SynopsisGuttate 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.
L40.4 – Guttate psoriasis
37042000 – Guttate psoriasis
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.
Patient Information for Guttate psoriasis in Child
OverviewGuttate psoriasis is a common skin rash that typically affects children, adolescents, and young adults. The rash can be described as thick and scaly patches on the skin. This disease is triggered most commonly 2 weeks after a strep throat infection or a viral infection. About 80% of patients with guttate psoriasis were found to have had a strep infection previously, usually in the throat but sometimes around the anus.
Guttate means "drop" in Latin, and the skin condition usually has small salmon-pink droplike spots with fine scaly surface around the arms, legs, and trunk (midbody area). The rash may spread to other areas such as the face and scalp. Scientists believe that psoriasis is caused by your white blood cells (immune system) making your skin get too thick and dry.
Guttate psoriasis is not contagious. The rash can clear up within a few weeks without any treatment, but it can also be the first sign of long-lasting psoriasis. Around 50% of people with guttate psoriasis will develop another form of psoriasis later in life.
Who’s At RiskGuttate psoriasis primarily affects people younger than 30 years old. It affects men and women equally.
Signs & SymptomsThe most obvious symptoms of guttate psoriasis are small pink drop-shaped scaly spots that show up 2-3 weeks after a strep infection (usually infection of the throat or tonsils). The rash may be covered with silver, flaky dry skin. The rash is usually on the arms, legs, and trunk but can spread to the face or scalp.
Self-Care GuidelinesSelf-care measures will not cure guttate psoriasis but can help decrease the symptoms depending how severe they are.
Taking baths daily can help calm the inflamed skin and help remove the thickened dry skin. Soaking for 15 minutes with bath oil, Epsom salts, or "Dead Sea salts" can help. Hot water and harsh soaps should be avoided, however, as they may make things worse.
Using an ointment-based moisturizer will help keep the skin moist, especially after a bath. During cold, dry weather putting on moisturizer several times a day may be necessary. Some over-the-counter creams or ointments that may help to reduce itching and scaling are those containing salicylic acid or hydrocortisone.
Aloe vera cream may reduce scaling, itching, and redness. Fish oil supplemented with omega-3 fatty acids may reduce redness as well.
Too much sun can trigger and worsen outbreaks, so limiting exposure to sunlight can also help (short periods of sun exposure while using sunscreen [at least SPF 15] 3-5 times a week is okay). Because you are reducing your sun exposure, vitamin D may be taken as a supplement, since the body's ability to make vitamin D requires sun on the skin.
Several herbs and foods to include in your diet that may slow down inflammation are garlic, red peppers, ginger, cumin, anise, basil, turmeric, rosemary, and pomegranate.
When to Seek Medical CareIf symptoms of guttate psoriasis develop and do not improve with time, seek advice from your physician. Lesions typically last a few weeks and fade away; however, guttate psoriasis can develop into chronic plaque psoriasis.
TreatmentsThe goal of treating guttate psoriasis is to reduce inflammation, thickened skin, and irritation. The choice of treatment should be tailored to the individual, and your physician may change treatment depending on how well you respond.
Topical corticosteroids (steroids) are the most common successful treatment. There are several different strengths that may be used, depending on the severity and body location. Lower-strength steroids are usually used for sensitive areas such as the face. Stronger steroids may be prescribed for other areas on the body, and the most potent steroids are typically prescribed for thick spots, especially on the arms and legs or hands and feet. Long-term use or overuse of strong steroids can decrease effectiveness and cause thinning of the skin. To avoid this, it is best to use steroids during an outbreak and then stop once the outbreak is under control.
Guttate psoriasis is commonly seen after a strep infection; a variety of antibiotics are commonly prescribed to patients with bacterial infections. These antibiotics include erythromycin, penicillin, azithromycin, and rifampin.
Ultraviolet light therapy (UV), also known as phototherapy, is another option to help improve psoriasis. This treatment can be done with natural or artificial ultraviolet light. The easiest way is to expose the skin to controlled amounts of natural sunlight. However, there are several artificial lighting therapies used as well in doctors' offices. Consult with your doctor on the best approach for you.
Vitamin D-related creams may also be prescribed to help reduce symptoms. Calcipotriene is a prescription cream that is commonly prescribed to treat mild to moderate psoriasis. Other forms of psoriasis are commonly treated with injectable drugs called "biologics," but these are not typically used for guttate psoriasis. In most cases, it is best to avoid steroid pills taken by mouth.
Chisholm, Cary. Guttate psoriasis. Medscape website. http://emedicine.medscape.com/article/1107850-overview. Updated May 4, 2012. Accessed April 16, 2013.
McPhee S, Papadakis M. Current Medical Diagnosis and Treatment. 51st ed. New York, NY: McGraw-Hill; 2012.
Porter, R., Kaplan, J., & Homeier, B. The Merck Manual Home Health Handbook. 3rd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2009.
Traub, Michael, and Keri Marshall. Psoriasis--pathophysiology, conventional, and alternative approaches to treatment. Altern Med Rev. 2007;12(4):319-328.
Guttate psoriasis in Child