Key takeaways

  • Guttate psoriasis is a less common type of psoriasis characterized by small, drop-like spots on the skin, often triggered by a streptococcal infection.
  • Symptoms can appear differently on various skin tones. On lighter skin, they often appear as raised, itchy pink or red spots, while on darker skin, they may look violet or brown.
  • While guttate psoriasis often resolves within a few months, some individuals may develop chronic plaque psoriasis. Managing the condition involves using topical treatments and addressing underlying infections

Guttate psoriasis is a variant of psoriasis usually triggered by an untreated streptococcal infection, among other causes.

In lighter skin tones, it can present as raised, itchy, pink, or red scaly spots. In darker skin tones, these spots can appear violet or brown. The name comes from the Latin word “guttate,” meaning “drop.”

Guttate psoriasis is not common. Less than 30% of psoriasis is guttate psoriasis. It usually presents in children and adults under the age of 30 years.

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Guttate psoriasis develops with characteristic small, red, violet, or brown scaly skin patches resembling drops. These lesions tend to be smaller than those of plaque psoriasis, though both types of psoriasis can occur at the same time.

Guttate psoriasis can appear almost anywhere on the body, including the:

  • elbows
  • knees
  • scalp
  • lower back
  • arms
  • legs
  • ears
  • face

Psoriasis can affect the skin of the fingernails and toenails. It can also affect the armpits, groin, and under the breasts, where it can develop as inverse psoriasis. This is when psoriasis develops inside the folds of the skin.

How does guttate psoriasis present on dark skin?

Guttate psoriasis generally causes small pink, violet, or brown spots.

In darker tones, it may be harder to see the changes to the skin, and people are more likely to experience hyperpigmentation. Hyperpigmentation occurs when patches of skin become darker than the surrounding area.

The following images represent how guttate psoriasis may appear on different skin tones:

In many cases, streptococcal infections trigger guttate psoriasis. However, other potential triggers may include:

There are also reports of COVID-19 triggering guttate psoriasis.

Guttate psoriasis is not contagious. However, the infections that may trigger it can be. Symptoms typically show 2 to 3 weeks after infection. It is the only type of psoriasis that progresses due to an acute viral or bacterial infection.

It is possible to have strep throat or another viral or bacterial infection without showing symptoms. For this reason, guttate psoriasis might seem to have a sudden, unexplained onset.

People have a higher risk of developing guttate psoriasis if it runs in their immediate family.

A healthcare professional, usually a dermatologist, will typically diagnose guttate psoriasis by physical examination of the skin. A skin biopsy is not usually necessary.

A blood test can check if a person has or recently had a strep infection, which is the most common cause of the condition. This may help if people have the bacteria but no symptoms of an infection.

A doctor may also ask about any recent bouts of strep throat or other infections, as these may trigger guttate psoriasis in children. They may also order a throat swab to test for infections.

Similar conditions

During a diagnosis, a doctor may rule out conditions with similar symptoms, including:

These conditions can occur alongside an outbreak of guttate psoriasis.

Guttate psoriasis symptoms are usually manageable with treatments. However, the rash can be very itchy, and people can get a secondary skin infection from scratching.

Even without treatment, guttate psoriasis typically resolves on its own in 3 to 4 months. However, about 25% of people with guttate psoriasis will develop chronic plaque psoriasis.

Someone with psoriasis can have other comorbidities, including:

Treating guttate psoriasis can be challenging. It is important to rule out untreated strep infection as a cause of guttate psoriasis, as a doctor can treat this with oral antibiotics, and the rash may resolve.

Doctors may also recommend topical medications for guttate psoriasis. Applying these to the skin may relieve itching and fade the lesions.

Topical corticosteroids are the first-line treatment. Other topical options may include:

Prescription shampoos can help with dryness and itching on the scalp. Doctors may also suggest phototherapy, which uses ultraviolet light, with either narrow or broadband UVB treatment.

People with psoriasis might also benefit from counseling or psychotherapy to manage depression or anxiety.

The following home remedies may also relieve guttate psoriasis symptoms:

  • Epsom salt baths
  • avoiding soaps or products containing perfumes
  • moisturizing regularly
  • exercising regularly
  • avoiding or quitting smoking
  • reducing or avoiding alcohol

It is important not to use exfoliating products and not scratch the area, as this may worsen a person’s symptoms.

Sometimes, psoriasis may leave a person feeling self-conscious. Self-care tips may include wearing loose clothing to feel more comfortable.

Monitoring triggers may help a person avoid them in the future. It is important to monitor for symptoms and any signs of relapse to ensure prompt treatment.

People can apply a moisturizer or scale softening product or take a cold bath to relieve itching. Avoiding known triggers can reduce symptom flare-ups.

If the itch is too overwhelming, prescription steroids or antihistamines can help reduce the symptoms and inflammation of guttate psoriasis, which can help reduce the itching.

There is no cure for guttate psoriasis. However, for some people, flare-ups may resolve in 3 to 4 months without treatment. Some people may never get it again, while for others, it may come back with another strep infection.

People with guttate psoriasis for a year or longer are more likely to develop chronic plaque psoriasis.

The best way to stop psoriasis from spreading is to continue with a regular course of treatment, which may include medical and home remedies. People can also do their best to avoid scratching or traumatizing the skin and wear comfortable clothing.

A doctor can diagnose and treat guttate psoriasis effectively. Often, the rash clears completely, even without treatment. However, in about 25% of people, it develops into chronic plaque psoriasis.

People may develop guttate psoriasis more than once. The most common trigger for a flare-up is Streptococcus bacteria infection.

Someone with guttate psoriasis symptoms can visit a doctor to rule out other conditions that present similarly. A doctor can prescribe suitable treatment for their skin lesions and any underlying infections.