Guttata psoriasis

Generality

Psoriasis guttata is an inflammatory disease of the skin, transient or chronic, which causes above all on arms, legs, chest and abdomen, small pink or red, drop-shaped spots covered by scales and itchy skin.

According to studies conducted so far, guttate psoriasis would be a genetic disease, the manifestation of which would occur only when certain events occur, including, for example, group A beta-hemolytic streptococcus infections responsible for pharyngotonsillitis.

Guttate psoriasis tends to heal spontaneously within a few weeks; however, doctors advise using a symptom control therapy anyway.

Brief review of psoriasis

Psoriasis is an inflammatory pathology of the skin, almost always chronic-relapsing, of a non-contagious nature, which occurs as a result of hyperproliferation of epidermal keratinocytes and is the cause of distinctive rashes (eg scales, silvery plaques, reddish patches etc.). ) in various parts of the body, including in particular: scalp, armpits, elbows, hands, knees and feet.

Psoriasis belongs to the category of autoimmune diseases, that is diseases characterized by an exaggerated or improper response of the immune system, towards the body that the immune system in question should instead protect.

What is Guttata Psoriasis?

Psoriasis guttata is a particular type of psoriasis, which produces, especially on the legs, arms and anterior part of the trunk, the characteristic pink-red spots, with a scaly and drop-shaped or tear-shaped appearance.

Did you know that ...

Doctors and experts in the field of pathology recognize the existence of 5 types of psoriasis: plaque psoriasis (the most common type of all), inverse psoriasis, erythrodermic psoriasis, pustular psoriasis and the subject of discussion of this article, guttate psoriasis.

Origin of the name

In the expression "psoriasis guttata" there is a reference to the teardrop shape of the characteristic pink-red spots of the medical condition under consideration in this article. The term "guttata", in fact, derives from the Latin word " gutta ", which in Italian means "drop".

Epidemiology

Responsible for a good 10% of total psoriasis cases, guttate psoriasis is the second most common type of psoriasis in the general population; before her, in fact, there is only plaque psoriasis, which characterizes about 80% of all psoriasis cases.

A rare condition among adults over the age of 30, guttate psoriasis mainly affects children and adolescents (so much so that exclusively for these two categories of individuals it is the most common type of psoriasis).

Ad hoc scientific studies have amply demonstrated that guttate psoriasis lacks a particular predilection for a certain sex.

Causes

The precise causes of guttate psoriasis are unknown. However, according to the unanimous opinion of the medical community, the skin disease in question would be a genetically based disease, whose manifestation would occur only when certain events occurred; in other words, doctors believe that, to suffer from guttate psoriasis, it is not enough to be carriers of a certain genetic alteration, but it is also necessary to be involved in specific events or situations.

In the list of these events / situations - which the experts in the sector indicate with the English word triggers - fall:

Group A beta-hemolytic streptococcus infections that produce pharyngitis, combined with tonsillitis (pharyngitis). An interesting statistical research on a group of guttate psoriasis patients found that about 80% of the cases considered had suffered, shortly before the onset of the cutaneous disease in question, from a pharyngotonsillitis caused by beta-hemolytic Streptococcus of group A;

Viral infections that cause some well-known diseases, such as chickenpox, rubella, measles and the common cold ;
Sunburns, scratches, burns and injections . In a context of guttate psoriasis and other related diseases, when an insult or injury to the skin triggers the typical rash of the present condition, the doctors talk about Koebner 's phenomenon ;
Intake of certain drugs, including lithium, antimalarials, indomethacin, quinidine and inderil ;
The strong stress ;
Excessive alcohol consumption .

Based on what the doctors report on the subject, triggers would not have the same impact on any individual predisposed to guttate psoriasis; this means that a trigger capable of triggering the typical rash in a person could be completely without consequences in another subject.

The precise mechanism by which triggers make the genetic alteration responsible for guttate psoriasis manifest is completely unknown.

Risk factors

In people with a predisposition to guttate psoriasis, the main factors favoring the latter are: juvenile age and group A beta hemolytic streptococcus infections.

Symptoms and Complications

Initially, guttate psoriasis occurs, on the arms, legs, thorax and / or abdomen, with small red or salmon spots, slightly itchy and teardrop-shaped or teardrop; after which, in the weeks following the onset, it progressively evolves, causing an enlargement of the initial spots and the formation on these latter of silver scales, scales that are subject to a gradual exfoliation .

In the cases of guttate psoriasis, by now consolidated (that is, present for some time), the pink / red spots can be as large as the diameter of an inch and, due to the amplitude, they can flow into one another, giving the impression of being a single entity not defined.

Still in the most advanced stages of guttate psoriasis, it may happen that the aforementioned cutaneous manifestations also invade other parts of the body, such as the ears, the face, the eyelids, the back, the ass, the neck and the scalp; it is necessary, however, to point out that the invasion by guttate psoriasis of areas different from the more usual ones (arms, legs, etc.) is quite unusual.

Guttate psoriasis is potentially able to present itself all over the body; the only anatomical areas that almost never interest are the palms of the hands and the soles of the feet.

Sporadic or chronic disease?

In about 2/3 of patients, guttate psoriasis shows signs of itself once in a lifetime or in any case a very small number of times (in these situations, it is called sporadic or transient disease); in the remaining 1/3, on the other hand, it has all the characteristics of a chronic disease, which alternates moments of apparent healing with moments of severe symptomatology.

Despite numerous studies on the subject, the reasons why guttate psoriasis is a sporadic illness, for someone, and chronic, for someone else, are completely unknown.

Did you know that ...

In cases where guttate psoriasis occurs after group A beta hemolytic Streptococcus infection, the first symptoms usually appear within 3 weeks of the infectious event.

Similar conditions associated

Guttate psoriasis is sometimes associated with another type of psoriasis: the aforementioned plaque psoriasis .

Plaque psoriasis affects mainly elbows, knees, scalp and part of the back, and is responsible for raised and well-defined red patches, in which silvery-white, thick and dry scales emerge.

Influence of the season

Looking at the course of guttate psoriasis during the 12 months of a year, it is possible to notice that the typical rash of the condition in question tends to be more severe during the winter, than during the summer. The doctors believe that, at the base of this seasonal behavior, there is a positive influence of the summer climate on the symptomatology (that is, the summer climate involves a general improvement of the symptom picture).

Complications

Guttate psoriasis can degenerate and be the protagonist of some important complications; among these complications, include:

The chronic nature of the symptomatology, ie the periodic recurrence of the typical symptoms and signs. As already stated, guttate psoriasis has the characteristics of a chronic condition in about 1/3 of patients.
Dyslipidemias . For unknown reasons (but certainly not dependent on a wrong lifestyle), guttate psoriasis is sometimes associated with conditions such as high cholesterol (hypercholesterolemia) and high triglycerides (triglyceridemia);
Plaque psoriasis . Plaque psoriasis is a complication, because it is a chronic disease and because, in severe cases, it is a cause of considerable aesthetic discomfort.
Plaque psoriasis can sometimes replace guttate psoriasis.
Skin infections . When the itching due to the spots is very intense, the patient with guttate psoriasis can injure himself by scratching and the resulting skin wounds can become infected. The infections in question may have a bacterial or fungal origin.
Psoriatic arthritis . Statistics show that around 10% of patients with recurrent guttate psoriasis develop a more or less severe form of psoriatic arthritis in their lifetime. The reasons behind this association are completely unknown.

When should I go to the doctor?

In general, training without plausible explanations of spots on the skin is always a good reason to contact the attending physician and arrange a visit to him, to investigate the situation.

The timely identification of guttate psoriasis is useful, because it allows to act on the disease when the symptomatology is still contained and the risk of infection is low; moreover, it allows the patient to inform himself on time about the remedies and the effective behaviors to control the symptoms.

What to do in case of infection?

If infectious processes take place in the skin areas subjected to guttate psoriasis, the person concerned must immediately contact their doctor, in order to receive instructions on the most appropriate treatment.

In such circumstances, carelessness can have unpleasant consequences.

Diagnosis

For the diagnosis of guttate psoriasis, the following are sufficient: the patient's account of symptoms, medical history and physical examination .

However, in these investigations, doctors have the tendency to add, with the sole purpose of investigating the present situation, tests such as: blood tests (for the research of group A beta-hemolytic Streptococcus), a pharyngeal swab (also it for the research of beta A hemolytic Streptococcus group A) and a skin biopsy (clearly, the biopsy cells come from the site of the spots).

Curiosity

The hallmark of guttate psoriasis - the sign that allows psoriasis to be distinguished from other forms of psoriasis - are the pink-red drop-shaped spots.

Therapy

Before discussing the treatment of guttate psoriasis it is necessary to clarify that:

Except in a limited number of cases, guttate psoriasis tends to heal spontaneously within a few weeks;
The remedies for guttate psoriasis are uniquely symptomatic (ie aimed at counteracting the symptoms), as doctors and pathologists have not yet identified a specific cure, able to accelerate the definitive healing process (or cure chronic cases).

For the control of guttate psoriasis symptoms, the possible treatments available to patients are:

Topical corticosteroids;
Phototherapy;
Creams or ointments with moisturizing and emollient properties;
Mineral tar based lotions;
Vitamin A (or its derivatives) for topical application;
Vitamin D (or its derivatives) for topical application;
Immunosuppressive drugs.

Furthermore, it is also important to add to these therapeutic remedies the antibiotic countermeasures to be taken in case of group A beta haemolytic streptococcus infections and antibiotic or antifungal countermeasures to be implemented in case of skin infections related to intense itching.

Topical corticosteroids

Topical corticosteroids are drugs in the form of a cream with high anti-inflammatory capacity.

In the presence of guttate psoriasis, the correct use of these drugs involves their application where there are pink-red spots.

Thanks to their remarkable efficacy, topical corticosteroids represent the first-line symptomatic treatment of reverse psoriasis; however, if used for long or inappropriately, they are responsible for several adverse effects, including thin skin, appearance of stretch marks, telangiectasia and excessive growth of body hair.

Important!

The use of corticosteroids always requires some caution; therefore, before using them or before increasing their dosage, it is good practice to consult your doctor and rely on his instructions.

Phototherapy

Phototherapy is a therapeutic technique based on the use of a light source, which emits UVB radiation.

In a context of guttate psoriasis, the patient's exposure to these radiations slows down the growth of the cells that characterize the typical spots of the present condition.

The use of phototherapy, as a remedy for the control of disorders related to guttate psoriasis, is foreseen only in clinical cases with protracted or chronic symptoms.

Unfortunately, and for reasons still unknown, not all patients with guttate psoriasis respond positively to phototherapy.

Products (creams or ointments) with moisturizing and emollient properties

Moisturizing and emollient products are used to alleviate skin dryness, related to the presence of scales, and to counter the consequences of exfoliation processes (which see the above scales as protagonists).

Moisturizing and emollient products include: paraffin, sweet almond oil, ichthyosis and glycerin.

Mineral tar based lotions

Mineral tar is useful in the presence of guttate psoriasis, because it slows down the cellular exchange process characteristic of the cutaneous areas covered by the patches and because it has a localized anti-inflammatory effect (therefore it reduces the sense of itching).

Vitamin A and vitamin D for topical application

Topical vitamin A and vitamin D are among the symptomatic treatments of guttate psoriasis, as they improve the appearance of pink-red spots and accelerate their disappearance.

Unfortunately, however, they have two drawbacks: only a few patients are inexplicably effective and can be irritating to the skin, even when used correctly.

Immunosuppressive drugs

Immunosuppressants are medicines that can reduce the effectiveness of immune defenses.

In the presence of an autoimmune disease such as guttate psoriasis, the properties of immunosuppressants are useful, because they alleviate the effects deriving from the malfunctioning of the immune system.

Used exclusively when the symptomatology is persistent and does not respond to any other symptomatic treatment, the most adopted immunosuppressants in the control of guttate psoriasis are ciclosporin and methotrexate, both systemically administered.

Antibiotic treatment of streptococcal infections

Where guttate psoriasis is associated with group A beta-hemolytic streptococcus infection, antibiotic treatment of the latter often has a positive impact on the symptoms of guttate psoriasis itself. This interesting effect supports the hypothesis that there is a close dependence between the two circumstances.

Prognosis

Guttate psoriasis tends to have a benign prognosis; as stated in more than one circumstance, in fact, it is often the protagonist of a spontaneous healing process, which ends positively (therefore without aftermath) within a few weeks.

Obviously, where spontaneous healing does not take place and, indeed, the symptomatology becomes chronic, guttate psoriasis assumes all the characteristics of a condition with an unpleasant prognosis.