Introduction

Guttate psoriasis is more common in children and adolescents. It may be precipitated by a streptococcal infection 2-4 weeks prior to the lesions appearing.

Epidemiology

  • Incidence: 5.00 cases per 100,000 person-years
  • Peak incidence: 30-40 years
  • Sex ratio: 1:1
Condition Relative
incidence
Pityriasis rosea34.00
Guttate psoriasis1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Clinical features

Features
  • teardrop papules on the trunk and limbs

Differential diagnosis

Differentiating guttate psoriasis and pityriasis rosea

Guttate psoriasisPityriasis rosea
ProdromeClassically preceded by a streptococcal sore throat 2-4 weeksMany patients report recent respiratory tract infections but this is not common in questions
Appearance'Tear drop', scaly papules on the trunk and limbsHerald patch followed 1-2 weeks later by multiple erythematous, slightly raised oval lesions with a fine scale confined to the outer aspects of the lesions.

May follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a 'fir-tree' appearance
Treatment /
natural history
Most cases resolve spontaneously within 2-3 months
Topical agents as per psoriasis
UVB phototherapy
Self-limiting, resolves after around 6 weeks

Management

Management
  • most cases resolve spontaneously within 2-3 months
  • there is no firm evidence to support the use of antibiotics to eradicate streptococcal infection
  • topical agents as per psoriasis
  • UVB phototherapy
  • tonsillectomy may be necessary with recurrent episodes