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Authors: Dr Amy Stanway, Department of Dermatology, Waikato Hospital, Hamilton, New Zealand, 2004. Copy edited by Gus Mitchell. DermNet NZ Update October 2021
Guttate psoriasis is a form of acute psoriasis described as a shower of small, pink-red, scaly ‘raindrops’ that has fallen over the body.
Guttate psoriasis tends to affect children and young adults; it is the second most common form of psoriasis in children after chronic plaque psoriasis. Both sexes and all races can develop guttate psoriasis. It is often the first presentation of psoriasis for an individual, but can also be seen in those with known chronic psoriasis.
Guttate psoriasis typically develops 1–2 weeks after a streptococcal infection of the upper respiratory tract, particularly tonsillitis, or other sites such as perianal streptococcal dermatitis. Beta-haemolytic streptococci can directly stimulate skin-homing T-cell proliferation in the tonsils.
See also Guttate psoriasis images
These dermoscopy features are diagnostic and are seen in all skin types.
Guttate psoriasis is a clinical diagnosis, aided by dermoscopy, which can be confirmed on skin biopsy.
Examination and investigations should include a search for streptococcal infection.
Tests may include:
Guttate psoriasis often clears within 3-4 months, even without treatment. Patients with proven streptococcal infection triggering the guttate psoriasis have a good prognosis. However, it may recur with another episode of streptococcal infection.
Guttate psoriasis may become persistent and evolve into chronic plaque psoriasis. Approximately 25% of cases of guttate psoriasis develop chronic plaque psoriasis. An even higher rate of chronic psoriasis is seen in patients with guttate lesions persisting for 12 months or more.
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