Eruptive Psoriasis Guide: Managing Outbreaks and Preventing Spread

April 11, 2024

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Guttate psoriasis, also known as eruptive psoriasis, is an acute form of psoriasis characterized by small, red, drop-like lesions scattered across the body. This article provides an overview of guttate psoriasis – its causes, stages, symptoms and available treatment options.

What is Guttate Psoriasis?

Guttate psoriasis presents as numerous tiny (typically less than 1cm wide), red colored papules, often described as tear-drop shaped, scattered over the central body especially the trunk, arms, legs and scalp. The name itself comes from the Latin word ‘gutta’ meaning ‘a drop’.

It frequently follows an upper respiratory tract infection, most notably strep throat, and affects around 2% of all psoriasis patients. Guttate psoriasis can occur at any age but is more common in children and younger adults under 30 years. For some it may be the first manifestation of lifelong psoriasis vulgaris.

While guttate lesions tend to be small and discrete, a large number erupting simultaneously gives the appearance of an acute rash like red raindrops peppering the skin. The abrupt onset is what distinguishes this variant from chronic plaque psoriasis.

Common Signs and Symptoms

Alongside the small, scattered and red teardrop-shaped scaly papules, some other signs and symptoms of guttate psoriasis include:

  • Burning or itching skin
  • Pitted, discolored nails
  • Sore throat and fever preceding the rash
  • Fatigue and stiffness in joints

The guttate lesions themselves range from:

  • Pinhead sized tiny papules
  • Larger plaques around 0.5 – 1 cm wide
  • Raised and scaly surface
  • Tender, red and shiny
  • Drop-like shape

The most frequently affected areas include:

  • Trunk (chest, back, stomach)
  • Arms and legs especially thighs and shins
  • Neck and scalp

What Triggers Guttate Psoriasis?

The exact cause behind this variant erupting is not fully known. However, the most well-established guttate psoriasis causes include:

  • Strep throat infections triggering an abnormal immune response
  • Recent history of upper respiratory infections
  • Specific medications like antimalarials and beta-blockers
  • Injury to skin called the Koebner phenomenon
  • Emotional stressors and major life events

Genetic susceptibility, climate changes triggering flares and smoking may also play a role.

Usually 2-3 weeks after a strep infection, the guttate lesions abruptly appear suggesting the illness likely served to jumpstart the psoriasis process. However guttate psoriasis can occur without any recent infection as well.

Stages in Guttate Psoriasis Progression

The course of guttate psoriasis tends to follow a pattern with two key phases:

Eruptive Phase

This active phase marks the initial onset where numerous small (less than 1 cm wide) drop-like lesions suddenly erupt over the skin. The abrupt appearance of many tiny, scaly, red papules looks like rain drops peppering the skin and distinguishes guttate psoriasis.

During this eruptive phase, the lesions continue to spread out rapidly covering large areas of skin over the upper trunk, arms, legs and scalp regions.

Regression Phase

As the term suggests, the disease process reverses course during the regression stage. The guttate lesions stop spreading, inflammation starts to subside, scales clear up and gradual skin healing begins.

In most patients (around 60-100%), the lesions resolve fully within 3 to 4 months either on its own or with treatment. However in some cases, it may follow a chronic fluctuating course over a longer term.

Treatment and Management Approaches

While mild guttate psoriasis may heal naturally, getting medical advice as soon as possible enables timely treatment to relieve symptoms and achieve faster resolution.

First-line treatments focus on:

  • Moisturizers to minimize dry scaly skin
  • Topical steroids to reduce inflammation and itching
  • Topical forms of Vitamin D
  • Light therapy or phototherapy

For more severe widespread cases, systemic oral or injectable medications may be required including:

  • Methotrexate
  • Oral retinoids
  • Targeted biologic agents

Avoiding triggering factors like infections and skin injuries can help prevent recurrent flare ups. Long term management aims to control outbreaks and minimize skin lesions through continued treatment.

While no definitive cure for guttate psoriasis exists yet, treating the condition early and appropriately does enable disease control and prolonged remission.

Frequently Asked Questions

How do you stop guttate psoriasis from spreading?

Seeking prompt treatment, avoiding triggers like skin trauma, practicing stress management, maintaining a healthy diet and lifestyle can help restrict its spread. Topical creams, light therapy and oral medications may also be used to halt progression.

Does guttate psoriasis always recur?

In nearly 60% to 100% cases, the lesions fully resolve within 3 to 4 months without recurring. However in some patients, it follows a relapsing and remitting pattern with periodic flare-ups. Avoiding triggers can reduce recurrence risk.

Is sunlight good for guttate psoriasis?

Exposure to small measured doses of natural sunlight or UVB light therapy helps treat guttate lesions. However excessive sun exposure can exacerbate symptoms and should be avoided during active flare-ups.

How do you cure guttate psoriasis permanently?

Currently there is no permanent cure. But long term remission is possible through continued treatment using topical creams, light therapy and oral systemic drugs as required. This can keep outbreaks under control and symptoms to a minimum when followed diligently.

Does guttate psoriasis scar?

No scarring occurs with guttate lesions itself. However scratching the itchy papules may lead to skin trauma and secondary infections which risks scarring. Avoiding itching and prompt treatment ensure normal skin recovery without scars.

In Summary

  • Guttate psoriasis presents as small, red, tear-drop shaped scaly skin lesions
  • Often follows upper respiratory infections like strep throat
  • Affects children and young adults more frequently
  • Two key phases – abrupt eruptive onset followed by gradual regression
  • Combination treatment with topical, light-based and systemic drugs

Seeking medical advice right away at first signs allows early intervention to better control symptoms, achieve stability and reduce recurrence risk. While it tends to resolve within weeks to months, periodic flare-ups may occur in some patients needing long term management.

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