Guttate Psoriasis: Causes, Symptoms, Treatments, and Complications

Guttate psoriasis is a less common form of psoriasis that can develop suddenly after an infection like strep throat. Here’s how to recognize the signs and get the right medical care.

Medically Reviewed
Guttate psoriasis involves droplet-shaped spots that can appear anywhere on the body.Hercules Robinson/Alamy

People kept asking Carol Shurlow if she had poison ivy, to the point where she was no longer surprised by the question. Shurlow, 61, a resident of Columbus, Ohio, has been living with guttate psoriasis since she was 15. Until she began taking a biologic, “it was pretty much present all the time,” she says.

The term “guttate” comes from the Latin word “gutta,” meaning droplet or speck, which describes the appearance of guttate psoriasis.

Instead of the thick lesions that characterize plaque psoriasis, guttate psoriasis involves tiny spots — “and there can be hundreds,” says Jeffrey Sugarman, MD, PhD, a clinical professor in the departments of dermatology and family medicine at the University of California in San Francisco, and the medical director at Redwood Family Dermatology in Santa Rosa.

The spots can be covered with silver, flaky scales, similar to plaque psoriasis.

Guttate psoriasis can break out almost anywhere on the body, though like plaque psoriasis it appears most often on the trunk and limbs, Dr. Sugarman says.

While around 80 percent of people with psoriasis have plaque psoriasis, only about 8 percent have the guttate type, according to the National Psoriasis Foundation (NPF).

RELATED: 5 Tips for Managing Foot Psoriasis

6 Easy Snacks for Your Anti-Psoriasis Diet

These anti-inflammatory treats will satisfy your cravings, boost your overall health, and possibly reduce your risk of a psoriasis flare.
6 Easy Snacks for Your Anti-Psoriasis Diet

What Causes Guttate Psoriasis?

Very often, guttate psoriasis comes on suddenly. Strep throat is a common trigger, says Sugarman. 

So-called environmental factors seem to play a more important role in guttate psoriasis than in other types of psoriasis, he adds.

According to the University of Florida Health (UFHealth) and the NPF, guttate psoriasis can also be triggered by:

  • An upper respiratory infection — bacterial or viral
  • Tonsillitis
  • Stress
  • An injury to the skin such as an insect bite, burn, or cut
  • Medications, such as beta-blockers, which are used to treat heart conditions, and drugs that treat malaria
  • Excessive alcohol consumption

These triggers can cause guttate psoriasis in people who may have a family history or other risk factors for the disease.

RELATED: Is That Rash Psoriasis, or Is It Something Else?

People with weakened immune systems may be susceptible to severe guttate psoriasis, UFHealth says. This includes individuals with:

Shurlow doesn’t know what triggered her guttate psoriasis, but she was sick a lot as a kid. “I had asthma, and from when I was 4 until about 10, I got bronchitis a lot,” she recalls.

Shurlow does know that when she’s under stress, her guttate psoriasis symptoms tend to be worse. Also, two or three days before coming down with a cold or other illness, she would notice more spots. “I find it kind of strange,” she says. “It was like a warning sign that I was going to get sick.”

RELATED: How to Manage Psoriasis Flares in Sensitive Areas

How Is Guttate Psoriasis Diagnosed?

Dermatologists diagnose guttate psoriasis much as they do plaque psoriasis: mostly from the distinctive appearance of the rash, says Sugarman.

As part of the diagnosis, your doctor will ask whether you’ve had strep throat or another infection, and may do a skin biopsy and a throat culture to confirm the diagnosis, per UFHealth — though this isn’t often necessary. Your doctor may also ask whether you’ve been taking any new medications or supplements.

Most people get guttate psoriasis as children or young adults, according to the NPF. In older adults, it can often be a precursor to plaque psoriasis, and it often runs in families. But Shurlow says that in her family, only a cousin is also living with guttate psoriasis.

RELATED: 10 Celebrities With Psoriasis

How Is Guttate Psoriasis Treated?

Guttate psoriasis may go away on its own in a few weeks or months. If it doesn’t, it can be treated with topical medications, says UFHealth, though applying creams and ointments to the hundreds of tiny drops on your skin can be tedious. “I’ve done numerous steroid creams over the years,” Shurlow says. Dandruff shampoos and moisturizers may help, too, UFHealth says.

Phototherapy is often an effective treatment for guttate psoriasis. “Light therapy helped me a lot at first,” says Shurlow. But phototherapy can make your skin sensitive to light, UFHealth notes.

If you have a severe case, your doctor might prescribe oral or injectable medications to dampen your inflammatory response. Shurlow has been on a biologic for about 14 years, and it has really helped clear her skin. “I feel very fortunate that insurance has covered most of the cost,” she says. “I still have a copay, but it’s reasonable. And really, my skin has been much better since I’ve been on the biologic.”

Antistreptococcal treatment like penicillin or amoxicillin is sometimes used to treat the acute form of guttate psoriasis, especially in children and young adults, but when researchers in Brussels, Belgium, reviewed the literature, they found no evidence of its efficacy or safety. They published their findings in March 2019 in the Cochrane Database of Systematic Reviews.

More trials are needed to assess this guttate psoriasis treatment, they concluded.

Can There Be Complications From Guttate Psoriasis?

As with any type of psoriasis, guttate psoriasis may lead to complications.

“Some people can have one episode of guttate psoriasis when they are 12 years old and never have it again,” Sugarman says. “Others wind up with chronic psoriasis and some lipid abnormalities: high blood cholesterol and triglycerides.”

Guttate psoriasis can cause severe itching and, less frequently, serious skin infections, Sugarman says.

Work closely with your doctor to find the best treatment and make this condition easier to manage.

RELATED: How to Take Better Photos of Your Skin for a Psoriasis Telemedicine Visit