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'''Guttate psoriasis''' (also known as '''eruptive psoriasis''') is a type of [[psoriasis]] that presents as small (0.5–1.5&nbsp;cm in [[diameter]]) [[lesions]] over the [[upper trunk]] and [[proximal extremities]]; it is found frequently in young adults.<ref name="Fitz22">Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.</ref>{{rp|410}}<ref name="Andrews2">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. ISBN 0-7216-2921-0.</ref>{{rp|194}} Guttate psoriasis is classically triggered by a [[Bacteria|bacterial]] infection, usually an [[upper respiratory tract infection]].<ref>{{cite journal|year=2000|title=Treatment of Psoriasis: An Algorithm-Based Approach for Primary Care Physicians|url=http://www.aafp.org/afp/20000201/725.html|journal=Am Fam Physician|publisher=|volume=61|issue=|pages=725–33,736|doi=|pmc=|pmid=|vauthors=Feldman SR, Clark AR|accessdate=30 Mar 2011}}</ref>{{rp|726}}
'''Guttate psoriasis''' (also known as '''eruptive psoriasis''') is a type of [[psoriasis]] that presents as small (0.5–1.5&nbsp;cm in [[diameter]]) [[lesions]] over the [[upper trunk]] and [[proximal extremities]]; it is found frequently in young adults.<ref name="Fitz22">Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.</ref>{{rp|410}}<ref name="Andrews2">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. ISBN 0-7216-2921-0.</ref>{{rp|194}} The term "[[Guttae (medical)|guttate]]" is used to describe the drop-like appearance of skin lesions. Guttate psoriasis is classically triggered by a [[Bacteria|bacterial]] infection, usually an [[upper respiratory tract infection]].<ref>{{cite journal|year=2000|title=Treatment of Psoriasis: An Algorithm-Based Approach for Primary Care Physicians|url=http://www.aafp.org/afp/20000201/725.html|journal=Am Fam Physician|publisher=|volume=61|issue=|pages=725–33,736|doi=|pmc=|pmid=|vauthors=Feldman SR, Clark AR|accessdate=30 Mar 2011}}</ref>{{rp|726}}


== Signs and Symptoms ==
== Signs and Symptoms ==
For some people it starts as a throat infection, or [[strep throat]]. After the throat infection has cleared up the person can feel fine for several weeks before noticing the appearance of red spots. They appear small at first, like a dry red spot which is slightly itchy. When scratched or picked the top layer of dry skin is removed, leaving dry, red skin beneath with white, dry areas marking where flakes of dry skin stop and start. In the weeks that follow the spots can grow to as much as an inch in diameter. Some of the larger ones may form a pale area in the center which is slightly yellow. The guttate psoriasis can occur on any part of the body, particularly the legs, arms, torso, eyelids, back, bottom, bikini-line and neck. Generally the parts of the body most affected are seen on the arms, legs, back and torso.
Typically guttate psoriasis erupts after a throat infection, or [[strep throat]].<ref>{{Cite journal|last=Prinz|first=J. C.|date=2001-06-01|title=Psoriasis vulgaris--a sterile antibacterial skin reaction mediated by cross-reactive T cells? An immunological view of the pathophysiology of psoriasis|url=https://www.ncbi.nlm.nih.gov/pubmed/11422184|journal=Clinical and Experimental Dermatology|volume=26|issue=4|pages=326–332|issn=0307-6938|pmid=11422184}}</ref> Initially, when the throat infection has cleared up, the person can feel fine for several weeks before noticing the appearance of red spots. They appear small at first, like a dry red spot which is slightly itchy. When scratched or picked the top layer of dry skin is removed, leaving dry, red skin beneath with white, dry areas marking where flakes of dry skin stop and start. In the weeks that follow the spots can grow to as much as an inch in diameter. Some of the larger ones may form a pale area in the center which is slightly yellow.

Guttate psoriasis can occur on any part of the body, particularly the legs, arms, torso, eyelids, back, bottom, bikini-line and neck. The number of lesions can range from 5 to over 100.<ref name=":0">{{Cite journal|last=Langley|first=R. G. B.|last2=Krueger|first2=G. G.|last3=Griffiths|first3=C. E. M.|date=2005-03-01|title=Psoriasis: epidemiology, clinical features, and quality of life|url=http://ard.bmj.com/content/64/suppl_2/ii18|journal=Annals of the Rheumatic Diseases|language=en|volume=64|issue=suppl 2|pages=ii18–ii23|doi=10.1136/ard.2004.033217|issn=0003-4967|pmc=PMC1766861|pmid=15708928}}</ref> Generally the parts of the body most affected are seen on the arms, legs, back and torso.


== Causes ==
== Causes ==
Genetic and environmental factors can influence the predilection for guttate psoriasis. [[Human leukocyte antigen|Human leukocyte antigens]], especially those in the HLA-C group are associated with the skin disorder.<ref>{{Cite journal|last=Mallon|first=E.|last2=Bunce|first2=M.|last3=Savoie|first3=H.|last4=Rowe|first4=A.|last5=Newson|first5=R.|last6=Gotch|first6=F.|last7=Bunker|first7=C. B.|date=2000-12-01|title=HLA-C and guttate psoriasis|url=https://www.ncbi.nlm.nih.gov/pubmed/11122018|journal=The British Journal of Dermatology|volume=143|issue=6|pages=1177–1182|issn=0007-0963|pmid=11122018}}</ref> [[Beta hemolytic streptococci|Beta-hemolytic streptococci]] infection is the major contributing environmental factor. The typical route of infection is the upper respiratory system. Rarely it is also caused by a skin infection surrounding the anus (perianal streptococcal dermatitis).<ref>{{Cite journal|last=Patrizi|first=A.|last2=Costa|first2=A. M.|last3=Fiorillo|first3=L.|last4=Neri|first4=I.|date=1994-06-01|title=Perianal streptococcal dermatitis associated with guttate psoriasis and/or balanoposthitis: a study of five cases|url=https://www.ncbi.nlm.nih.gov/pubmed/8041660|journal=Pediatric Dermatology|volume=11|issue=2|pages=168–171|issn=0736-8046|pmid=8041660}}</ref><ref>{{Cite journal|last=Herbst|first=R. A.|last2=Hoch|first2=O.|last3=Kapp|first3=A.|last4=Weiss|first4=J.|date=2000-05-01|title=Guttate psoriasis triggered by perianal streptococcal dermatitis in a four-year-old boy|url=https://www.ncbi.nlm.nih.gov/pubmed/10767696|journal=Journal of the American Academy of Dermatology|volume=42|issue=5 Pt 2|pages=885–887|issn=0190-9622|pmid=10767696}}</ref>


== Diagnosis ==
== Diagnosis ==
Guttate psoriasis can typically be diagnosed by clinical examination alone.<ref>{{Cite web|url=https://www-uptodate-com/contents/guttate-psoriasis?source=search_result&search=guttate%20psoriasis&selectedTitle=1~12#references|title=Guttate psoriasis|last=Mehlis|first=Stephanie|date=3/26/2017|website=Up-to-date|archive-url=|archive-date=|dead-url=|access-date=}}</ref> If necessary, a skin biopsy can be used to support the diagnosis. It is commonly mistaken for Measles.
It is commonly mistaken for Measles.


== Management ==
== Management ==
The treatments used for [[plaque psoriasis]] can also be used for guttate psoriasis. Few studies have specifically focused on guttate psoriasis management, so there is currently no firm guidelines for managing guttate psoriasis differently from [[Plaque psoriasis|plaque psoriasis.]]<ref>{{Cite journal|last=Chalmers|first=R. J.|last2=O'Sullivan|first2=T.|last3=Owen|first3=C. M.|last4=Griffiths|first4=C. E.|date=2001-12-01|title=A systematic review of treatments for guttate psoriasis|url=https://www.ncbi.nlm.nih.gov/pubmed/11899141|journal=The British Journal of Dermatology|volume=145|issue=6|pages=891–894|issn=0007-0963|pmid=11899141}}</ref><ref>{{Cite journal|last=Chalmers|first=R. J.|last2=O'Sullivan|first2=T.|last3=Owen|first3=C. M.|last4=Griffiths|first4=C. E.|date=2000-01-01|title=Interventions for guttate psoriasis|url=https://www.ncbi.nlm.nih.gov/pubmed/10796758|journal=The Cochrane Database of Systematic Reviews|issue=2|pages=CD001213|doi=10.1002/14651858.CD001213|issn=1469-493X|pmid=10796758}}</ref> Due to the role streptococcal infection plays in the development of guttate psoriasis, systemic antibiotics have been considered as a potential treatment option. Although systemic antibiotics may be considered to treat the initial infection at its source, there is no support for their use in the management of subsequent guttate psoriasis itself.<ref>{{Cite journal|last=Owen|first=C. M.|last2=Chalmers|first2=R. J.|last3=O'Sullivan|first3=T.|last4=Griffiths|first4=C. E.|date=2001-12-01|title=A systematic review of antistreptococcal interventions for guttate and chronic plaque psoriasis|url=https://www.ncbi.nlm.nih.gov/pubmed/11899140|journal=The British Journal of Dermatology|volume=145|issue=6|pages=886–890|issn=0007-0963|pmid=11899140}}</ref> The condition often usually clears up on its own within weeks to months, and only about one third of patients will develop chronic plaques.<ref>{{Cite journal|last=Martin|first=Branwen A.|date=1996-06-01|title=How Great Is the Risk of Further Psoriasis Following a Single Episode of Acute Guttate Psoriasis?|url=http://jamanetwork.com/journals/jamadermatology/article-abstract/557877|journal=Archives of Dermatology|language=en|volume=132|issue=6|doi=10.1001/archderm.1996.03890300147032|issn=0003-987X}}</ref>
Treatment is often a mild steroid, such as [[hydrocortisone]], but this is not always effective. Other treatment include exposing the affected area of the skin to sunlight (while avoiding sunburn). The condition often but not always clears up on its own. Enthusiastic exfoliation can lead to bleeding so care and moisturization are important to keep the affected skin healthy.

== Epidemiology ==
Guttate psoriasis accounts for approximately 2% of psoriasis cases.<ref name=":0" />


==References==
==References==

Revision as of 15:45, 26 March 2017

Guttate psoriasis
SpecialtyDermatology Edit this on Wikidata

Guttate psoriasis (also known as eruptive psoriasis) is a type of psoriasis that presents as small (0.5–1.5 cm in diameter) lesions over the upper trunk and proximal extremities; it is found frequently in young adults.[1]: 410 [2]: 194  The term "guttate" is used to describe the drop-like appearance of skin lesions. Guttate psoriasis is classically triggered by a bacterial infection, usually an upper respiratory tract infection.[3]: 726 

Signs and Symptoms

Typically guttate psoriasis erupts after a throat infection, or strep throat.[4] Initially, when the throat infection has cleared up, the person can feel fine for several weeks before noticing the appearance of red spots. They appear small at first, like a dry red spot which is slightly itchy. When scratched or picked the top layer of dry skin is removed, leaving dry, red skin beneath with white, dry areas marking where flakes of dry skin stop and start. In the weeks that follow the spots can grow to as much as an inch in diameter. Some of the larger ones may form a pale area in the center which is slightly yellow.

Guttate psoriasis can occur on any part of the body, particularly the legs, arms, torso, eyelids, back, bottom, bikini-line and neck. The number of lesions can range from 5 to over 100.[5] Generally the parts of the body most affected are seen on the arms, legs, back and torso.

Causes

Genetic and environmental factors can influence the predilection for guttate psoriasis. Human leukocyte antigens, especially those in the HLA-C group are associated with the skin disorder.[6] Beta-hemolytic streptococci infection is the major contributing environmental factor. The typical route of infection is the upper respiratory system. Rarely it is also caused by a skin infection surrounding the anus (perianal streptococcal dermatitis).[7][8]

Diagnosis

Guttate psoriasis can typically be diagnosed by clinical examination alone.[9] If necessary, a skin biopsy can be used to support the diagnosis. It is commonly mistaken for Measles.

Management

The treatments used for plaque psoriasis can also be used for guttate psoriasis. Few studies have specifically focused on guttate psoriasis management, so there is currently no firm guidelines for managing guttate psoriasis differently from plaque psoriasis.[10][11] Due to the role streptococcal infection plays in the development of guttate psoriasis, systemic antibiotics have been considered as a potential treatment option. Although systemic antibiotics may be considered to treat the initial infection at its source, there is no support for their use in the management of subsequent guttate psoriasis itself.[12] The condition often usually clears up on its own within weeks to months, and only about one third of patients will develop chronic plaques.[13]

Epidemiology

Guttate psoriasis accounts for approximately 2% of psoriasis cases.[5]

References

  1. ^ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
  2. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
  3. ^ Feldman SR, Clark AR (2000). "Treatment of Psoriasis: An Algorithm-Based Approach for Primary Care Physicians". Am Fam Physician. 61: 725–33, 736. Retrieved 30 Mar 2011.
  4. ^ Prinz, J. C. (2001-06-01). "Psoriasis vulgaris--a sterile antibacterial skin reaction mediated by cross-reactive T cells? An immunological view of the pathophysiology of psoriasis". Clinical and Experimental Dermatology. 26 (4): 326–332. ISSN 0307-6938. PMID 11422184.
  5. ^ a b Langley, R. G. B.; Krueger, G. G.; Griffiths, C. E. M. (2005-03-01). "Psoriasis: epidemiology, clinical features, and quality of life". Annals of the Rheumatic Diseases. 64 (suppl 2): ii18–ii23. doi:10.1136/ard.2004.033217. ISSN 0003-4967. PMC 1766861. PMID 15708928.{{cite journal}}: CS1 maint: PMC format (link)
  6. ^ Mallon, E.; Bunce, M.; Savoie, H.; Rowe, A.; Newson, R.; Gotch, F.; Bunker, C. B. (2000-12-01). "HLA-C and guttate psoriasis". The British Journal of Dermatology. 143 (6): 1177–1182. ISSN 0007-0963. PMID 11122018.
  7. ^ Patrizi, A.; Costa, A. M.; Fiorillo, L.; Neri, I. (1994-06-01). "Perianal streptococcal dermatitis associated with guttate psoriasis and/or balanoposthitis: a study of five cases". Pediatric Dermatology. 11 (2): 168–171. ISSN 0736-8046. PMID 8041660.
  8. ^ Herbst, R. A.; Hoch, O.; Kapp, A.; Weiss, J. (2000-05-01). "Guttate psoriasis triggered by perianal streptococcal dermatitis in a four-year-old boy". Journal of the American Academy of Dermatology. 42 (5 Pt 2): 885–887. ISSN 0190-9622. PMID 10767696.
  9. ^ Mehlis, Stephanie (3/26/2017). "Guttate psoriasis". Up-to-date. {{cite web}}: Check |url= value (help); Check date values in: |date= (help); Cite has empty unknown parameter: |dead-url= (help)
  10. ^ Chalmers, R. J.; O'Sullivan, T.; Owen, C. M.; Griffiths, C. E. (2001-12-01). "A systematic review of treatments for guttate psoriasis". The British Journal of Dermatology. 145 (6): 891–894. ISSN 0007-0963. PMID 11899141.
  11. ^ Chalmers, R. J.; O'Sullivan, T.; Owen, C. M.; Griffiths, C. E. (2000-01-01). "Interventions for guttate psoriasis". The Cochrane Database of Systematic Reviews (2): CD001213. doi:10.1002/14651858.CD001213. ISSN 1469-493X. PMID 10796758.
  12. ^ Owen, C. M.; Chalmers, R. J.; O'Sullivan, T.; Griffiths, C. E. (2001-12-01). "A systematic review of antistreptococcal interventions for guttate and chronic plaque psoriasis". The British Journal of Dermatology. 145 (6): 886–890. ISSN 0007-0963. PMID 11899140.
  13. ^ Martin, Branwen A. (1996-06-01). "How Great Is the Risk of Further Psoriasis Following a Single Episode of Acute Guttate Psoriasis?". Archives of Dermatology. 132 (6). doi:10.1001/archderm.1996.03890300147032. ISSN 0003-987X.


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