The patient is a 16-year-old female who developed a rash 2 weeks ago. The dermatitis appeared suddenly and was preceded 10 days earlier by a streptococcal throat infection. She is otherwise in good health and takes no oral medications. She denies sexual activity. Examination reveals multiple erythematous papulosquamous patches on her trunk and extremities. Her face and scalp are unaffected.
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Guttate psoriasis is a variant of psoriasis that is seen most frequently in patients who are younger than 30 years old. Affected individuals present with the acute onset of small drop-like (guttate) papules and patches covered with a fine scale. The rash is usually on the trunk and extremities but can involve the entire body.1
Guttate psoriasis is often associated with a preceding pharyngeal or perianal streptococcal infection. Patients usually present shortly after the infection, and the condition may be misdiagnosed as a medication allergy.2
Diagnosis is made with patient history and clinical appearance. Guttate psoriasis usually resolves spontaneously within weeks to months without treatment. Topical steroids and ultraviolet B light hasten recovery,3 as may an oral antibiotic when precipitated by streptococcal infection.4
Rebecca Geiger, PA-C, is a physician assistant on staff at the DermDox Dermatology Center in Hazleton, Pennsylvania. Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
- Koufakis T, Gabranis I. First presentation of guttate psoriasis triggered by acute tonsillitis. Pan Afr Med J. 2014;17:273.
- Vence L, Schmitt A, Meadows CE, Gress T. Recognizing guttate psoriasis and initiating appropriate treatment. W V Med J. 2015;111:26-28.
- Altman K. Guttate psoriasis. Medscape. http://emedicine.medscape.com/article/1107850-overview. Updated April 17, 2017. Accessed on September 28, 2017.
- Owen CM, Chalmers RJ, O’Sullivan T, Griffiths CE. Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database Syst Rev. 2000;(2):CD001976.