Acute Guttate Psoriasis

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Basics ⬇

Acute guttate psoriasis refers to the sudden onset of multiple guttate (teardrop-shaped) psoriatic lesions (Fig. 14.11). It is often the initial presentation of psoriasis in children and young adults.
Guttate psoriasis is often preceded by a group A beta-hemolytic streptococcal infection (positive throat culture or serologic evidence of antistreptolysin O).

Clinical Manifestations ⬆

The typical presentation is an acute onset of numerous small (1 to 10 mm), guttate (teardrop-shaped), thin salmon-pink papules or plaques with a fine scale.
Lesions arise primarily on the trunk and proximal extremities, but may become generalized.
Some cases are self-limited; however recurrences may appear with repeated streptococcal pharyngitis.
Less often, guttate psoriasis may be chronic in nature without preceding streptococcal infection.

Differential Diagnosis

See discussion earlier in this chapter.

Pityriasis Rosea

Self-limiting.
Characteristic distribution.

Drug Eruption

Most often morbilliform without scale.

Parapsoriasis

The term “parapsoriasis” derives from the fact that the condition clinically resembles psoriasis, but in fact is a completely different entity.

Secondary Syphilis

Positive serology for syphilis.

Management

Appropriate antibiotic therapy, such as penicillin, amoxicillin, or erythromycin if there is clinical, bacteriologic, or serologic evidence of infection with group A beta-hemolytic streptococcus.
For limited plaques, a high-potency (class 1, 2, or 3) topical steroid can be used.
For more numerous plaques, UVB phototherapy or natural sunlight exposure two to three times per week can induce remission.