Guttate psoriasis causes small, round bumps. It’s typically triggered by a Streptococcus (strep) bacteria infection.
Guttate psoriasis most commonly affects children and adolescents. This condition is relatively common, affecting about 8% of people with psoriasis.
Guttate psoriasis on the back.
Reproduced with permission from © DermNet dermnetnz.org 2023.
Guttate psoriasis is an autoimmune condition. That means symptoms are caused by your body’s immune response (defense system) attacking your body’s own tissues. This causes inflammation.
In most cases, this inflammatory reaction is triggered by infection with bacteria called Streptococcus A (strep). Medications may also trigger guttate psoriasis.
Strep Infection
Strep infections that may trigger guttate psoriasis include:
- Pharyngitis (strep throat): This causes a sudden and severe sore throat, swollen lymph nodes (small, sac-like organs that are part of your immune system), and fever.
- Tonsillitis: This is an infection of your tonsils (the two pads of tissue in the back of your throat), which are part of your immune system. It causes swollen and red tonsils with a white or yellow coating. Other signs include fever, sore throat, bad breath, and swollen glands.
- Perianal dermatitis: This is a strep infection of the skin around the anus and rectum. It’s most common in children 10 or younger. It causes redness in the affected area.
Medications
Medications that impact immune function may also trigger guttate psoriasis flares. These include:
- Beta-blockers: These medications are for high blood pressure. Examples include Inderal (propranolol) and Tenormin (atenolol).
- Eskalith (lithium): This is a mood stabilizer drug for bipolar disorder.
- TNF-alpha antagonists: These treat certain autoimmune diseases. Examples include Remicade (infliximab) and Enbrel (etanercept).
- Antimalarial drugs: These treat malaria and parasite infections. Examples include Aralen (chloroquine) and Plaquenil (hydroxychloroquine).
What Affects Your Risk?
Guttate psoriasis affects males and females equally. However, if you have certain factors, your risk of developing guttate psoriasis may be higher. These factors may include:
- Age: Guttate psoriasis is most common in children, adolescents, and adults 30 or younger. Less often, people in other age groups can also be affected.
- Genetics: A family history of psoriasis raises your chances of guttate psoriasis. Researchers have linked the condition to mutations in a gene called PSORS1, among others.
- Autoimmune diseases: Rheumatoid arthritis, inflammatory bowel disease (IBD), and other autoimmune diseases are associated with a higher risk of guttate psoriasis.
- Chemotherapy: Chemotherapy’s effect on your immune system can raise your risk of guttate psoriasis.
- Respiratory infections: Like some staph infections, other infections of the upper respiratory tract (lungs, airways, and throat) can trigger flare-ups.
- Injury: A cut, scrape, or injury to the skin can also raise your chances of having symptoms.
The main signs of guttate psoriasis are flare-ups of discolored and raised dots or patches of skin, known as papules. These papules are very small and have a distinct, round teardrop-shaped appearance. They appear in clusters and are often itchy.
On lighter shades of skin, these teardrop-shaped bumps are red or pink. If you have darker skin, they may look light or dark brown or purple. These patches can develop silvery or white scales, which may flake off.
You can develop guttate psoriasis anywhere on the body. It most commonly affects the following areas:
- Torso, including your belly and back
- Arms
- Legs
- Face
- Ears
- Scalp
About 39% of people with guttate psoriasis symptoms develop plaque psoriasis, a chronic autoimmune condition that causes raised patches of scaly, itchy, and irritated skin.
Your healthcare provider may diagnose guttate psoriasis primarily by taking your medical history and doing a physical evaluation. You can expect them to examine your skin and ask about any recent infections or other potential triggers.
Sometimes, healthcare providers may request a skin biopsy. A biopsy can help your healthcare provider confirm guttate psoriasis and rule out other causes of your symptoms. The process involves collecting a small piece of skin and sending it to a lab for clinical evaluation.
There is a range of treatment options for guttate psoriasis. Medicated and non-medicated creams and shampoos may help with milder cases. For more severe or persistent cases, your healthcare provider may recommend oral medications, injections or infusions, and light therapy.
Non-Medicated Options
For mild cases or flares, creams, ointments, oils, and other products may help. These include:
- Moisturizers: Emollients and moisturizers combat itchiness by restoring the skin barrier (the natural layer of oil and skin that preserves moisture). Use products made with lipids (oils that make up the skin barrier) and ingredients that retain moisture, such as glycerin and urea.
- Coal tar: Coal tar is a common ingredient in a range of shampoos, moisturizers, topical solutions, and cleansers used to manage psoriasis. It helps remove scales and relieve itch, especially on the scalp.
- Dandruff shampoo: Prescription-strength or over-the-counter (OTC) anti-dandruff shampoos can help with outbreaks on the scalp.
Topical Medications
Medicated ointments, gels, or topical solutions—applied directly to affected areas—play a central role in managing psoriasis. These may help mild and moderate cases and include:
- OTC steroid creams and ointments with corticosteroids such as cortisone and hydrocortisone
- Prescription corticosteroid creams or gels like Aristocort (triamcinolone)
- Prescription shampoo made with clobetasol propionate
- Vitamin D analogues (topical retinoids), such as Calcitrene (calcipotriene)
- Tazorac (tazarotine), a prescription-strength topical vitamin A
- Anthralin (dithranol), a prescription topical medication for slowing skin growth
- Calcineurin inhibitors, topical steroids that can be used on sensitive areas like the face and skin folds
Oral Medications
For moderate to severe cases of guttate psoriasis, your healthcare provider may prescribe medications you take by mouth. These may include:
- Soriatane (acitretin), an oral retinoid vitamin A medication
- Xatmep (methotrexate), an immunosuppressive drug
- Neoral (cyclosporine), an immune suppressant
- Penicillin antibiotics for strep A infection, such as Amoxil (amoxicillin)
- Otezla (apremilast), a medication approved for plaque psoriasis but sometimes prescribed off-label for guttate psoriasis in adults
Injectable or Infusion Medications
Biologic medications are a newer approach reserved for severe cases of guttate psoriasis. They are delivered by injection or intravenous (IV) infusion and include:
- Humira (adalimumab)
- Skyrizi (risankizumab)
- Remicade (infliximab)
- Enbrel (etanercept)
- Stelara (Ustekinumab)
Light Therapy
Light therapy is also known as phototherapy. It involves regularly exposing your affected skin to ultraviolet B (UVB) rays, usually in a clinic. For moderate to severe guttate psoriasis, some research suggests that narrow-band UVB rays may be the most effective treatment.
Tonsillectomy
Surgery to remove your tonsils may be an option for recurring or severe guttate psoriasis triggered by tonsillitis. This treatment is typically reserved for cases where other treatments haven’t worked. Overall, the evidence is not conclusive, and more research is needed to determine who may benefit from this surgery.
Guttate psoriasis is a skin condition that causes patches of red, teardrop-shaped bumps on the skin. These outbreaks generally occur 1-3 weeks after exposure to a trigger, such as infection with staph bacteria.
Treatment options for guttate psoriasis include moisturizing products, medicated creams, topical and oral medications, injectable medications or infusions, and light therapy.
