​Guttate psoriasis is a form of psoriasis that primarily affects children and young adults. According to the National Psoriasis Foundation, about 8 percent of people with psoriasis develop guttate psoriasis, the second most common type after plaque psoriasis.

Small, discolored, scaly, teardrop-shaped spots on the arms, legs, and torso are characteristic of guttate psoriasis. Lesions typically develop suddenly, following a bacterial infection such as strep throat. Guttate psoriasis is not contagious, and spots often clear with treatment, though in some people it can later return as plaque psoriasis.

What Causes Guttate Psoriasis?

The cause of guttate psoriasis is not completely understood. Like plaque psoriasis, guttate psoriasis is believed to be caused by an overactive immune system that creates inflammation and overproduces skin cells, according to the American Academy of Dermatology.

What Is the Trigger of Guttate Psoriasis?

In many cases, strep throat appears to be the main trigger of guttate psoriasis. Other possible triggers include:

• Upper respiratory infection
• Tonsillitis
• Skin injury
• Some medications (including beta-blockers and antimalarial drugs)
• Stress
• Sunburn
• Excessive alcohol consumption

Risk factors for guttate psoriasis include a family history of skin disease. People with psoriasis in general also have a higher risk of developing psoriatic arthritis, obesity, certain eye conditions, cardiovascular disease, type 2 diabetes, and other autoimmune disorders, including Crohn’s disease.

Symptoms of Guttate Psoriasis

Guttate psoriasis can appear quickly. Symptoms include tiny discolored bumps (called papules) that are raised, scaly, and possibly itchy. The spots typically cover the torso, arms, and legs but can appear elsewhere on the body. Guttate lesions are not generally as thick as those of plaque psoriasis.

Diagnosis is usually made with a visual examination of lesions and a medical history. A dermatologist may order tests to confirm the diagnosis that include a throat culture and blood work to detect elevated levels of strep bacteria. A skin biopsy is sometimes performed but usually isn’t necessary.

Speak with your dermatologist if you develop guttate psoriasis after a strep throat infection.

Treatments for Guttate Psoriasis

Treatment for guttate psoriasis aims to clear the skin of lesions as long as possible. Depending on the severity of symptoms, treatments can include over-the-counter topical lotions, phototherapy, or medications that suppress the body’s immune system activity. Your dermatologist may recommend one or more of the following treatment options.

Topical Treatments

For mild guttate psoriasis covering less than 3 percent of the body, dermatologists typically recommend topical creams or ointments that help relieve itching, scaling, and discoloration. They include over-the-counter and prescription topical treatments (available in creams, ointments, or lotions) in combination with moisturizers.

Over-the-Counter Topicals

Salicylic acid and coal tar — low-potency agents found in nonprescription creams, gels, and lotions — can help manage mild to moderate symptoms of guttate psoriasis. Cortisone or other anti-itch creams may also be recommended.

Topical Steroids

High-potency topical corticosteroids can help reduce swelling and discoloration by blocking inflammatory responses in the body. Steroids come in various strengths and should be used sparingly on small areas of the body for no longer than three weeks to avoid skin thinning and changes in pigmentation.

Nonsteroidal Topicals

Nonsteroid prescription topicals — such as vitamin A-derivative tazarotene (Tazorac) and calcipotriene (Dovonex), a synthetic form of vitamin D — are often prescribed to treat general psoriasis. Unlike steroids, however, these drugs don’t cause skin thinning.

Topical calcineurin inhibitors, such as tacrolimus (Protopic) and pimecrolimus (Elidel), suppress the immune system to control inflammation and can be used longer than steroids. Approved for atopic dermatitis, they can be prescribed off-label to treat guttate lesions in combination with steroid topicals or systemic treatments.

Phototherapy

Light therapy, also called phototherapy, is often the first treatment for people with moderate to severe guttate psoriasis that covers a large part of the body. The most common type is narrowband ultraviolet B (UVB) light, which helps calm inflammation and slow the fast growth of skin cells.

In the past, doctors sometimes used a treatment called psoralen plus UVA light (PUVA). Because PUVA can raise the risk of skin cancer over time, it is now used much less often. Today, narrowband UVB is the preferred choice for most people.

Disease-Modifying Antirheumatic Drugs

Doctors sometimes use medicines called disease-modifying antirheumatic drugs (DMARDs), which usually come as pills but can also be given as shots to help calm the immune system. These are usually considered if using creams or light therapy isn’tenough. Older DMARDs, such as methotrexate and cyclosporine, can help but are usually used short term because of possible side effects.

There are also newer oral treatments that work in different ways. For example, there are medicines called phosphodiesterase inhibitors and tyrosine kinase 2 inhibitors, which target specific signals in the immune system that cause inflammation. These newer medicines are often easier to take and may cause fewer long-term risks compared with older drugs.

Biologics

Biologic drugs target parts of the immune system that cause inflammation. They are given by injection or infusion. They are not a standard treatment for guttate psoriasis, and most guidelines recommend creams or light therapy first.

There have been a few small studies and case reports testing biologics in guttate psoriasis. For example, the biologic ustekinumab showed improvement in some patients in case series. Other biologics have been tried in isolated case reports, but overall the evidence is very limited.

Because of this, biologics are generally considered only for severe cases that don’t respond to other treatments, and people taking them need careful monitoring because of possible side effects, such as infections.

Complementary Therapies for Guttate Psoriasis

To protect skin against irritation and injury, dermatologists also recommend a regular practice of home care that includes cleansing and moisturizing.

Moisturizers

Moisturizers are an important part of any psoriasis treatment. These over-the-counter lotions, creams, and ointments help soften and remove dead skin cells. A good moisturizer can prevent psoriasis from getting worse. Use a fragrance-free moisturizer daily, after bathing, and whenever the area feels dry.

Cleansing

Wash skin gently with mild, fragrance-free cleansers. Avoid irritating antibacterial soaps or body washes. Adding emollients, such as bath oil or oatmeal, to the water can soothe raw, painful skin. The National Psoriasis Foundation publishes a list of approved personal care products that can also help reduce symptoms of guttate psoriasis.

There are several popular natural remedies for psoriasis, which might also provide relief for those with guttate psoriasis:

• Dead Sea salts — Use in bathwater to reduce discoloration and soothe scaly skin, followed by moisturizer.
• Aloe vera — A 0.5 percent topical gel can cool itchy skin and relieve scaly lesions.
• Apple cider vinegar — Apple cider vinegar may relieve itching for the rare instances when guttate psoriasis appears on the scalp.
• Oats — Over-the-counter creams containing oats can help reduce itch when applied topically or added to bathwater.
• Tea tree oil — This natural antiseptic is an ingredient in some topical products.
• Turmeric — A natural anti-inflammatory, turmeric may help minimize flare-ups when taken orally or added to food.
• Capsaicin — A form of pepper, this ingredient in some over-the-counter creams may help reduce pain, inflammation, and discoloration.
• Mahonia aquifolium (Oregon grape) — An herb with powerful antimicrobial properties, mahonia 10 percent topical cream improved symptom severity in people with psoriasis when applied for several weeks.

Does Guttate Psoriasis Go Away?

Guttate psoriasis may clear up in a few weeks or months. For some people, however, it can develop into plaque psoriasis or flare up again after another throat infection. Be sure to consult your doctor if you experience symptoms of guttate psoriasis.

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