Guttate psoriasis L40.40

Clinical term for an eruptive-exanthematous psoriasis vulgaris with small focal, "drop-like" lesions. Mostly infection-triggered, exanthematous psoriasis guttata is the manifestation of psoriasis occurring predominantly in children. It is also frequently seen as the initial manifestation. However, the guttata type may also occur due to relapsing activity in previously chronic stationary plaque psoriasis, in addition to the existing psoriatic plaques. It is thus a special clinical manifestation form of psoriasis vulgaris.

About 2% of psoriasis patients suffer from psoriasis guttata.

The association with the high-risk PSORS1 gene, which maps to chromosome 6p21.3, has been described.

In the majority of cases (in children > 60%), guttate psoriasis is triggered by a previous streptococcal infection (mostly of the upper respiratory tract) (streptogenic antigens with structural similarities to keratinocyte proteins are discussed). See also tonsillectomy and psoriasis(psoriasis overview).

More rarely, it is triggered by a previous viral infection (e.g. zoster) or as a consequence of vaccination.

More frequent in children and adolescents (5-15 years) than in young adults (20-30 LJ). In childhood often as a first manifestation of psoriasis vulgaris. Less frequently in later life.

Trunk, extensor extremities. Face and mucous membranes are free. The capillitium may be involved.

Acute or chronic recurrent generalized exanthema with red, grey-red or grey-white papules and plaques 0.1-1.5 cm in size.

In the untreated state, a strong whitish scaling is characteristic. This can be easily scratched out even in the case of punctiform early lesions (the Auspitz phenomenon is always detectable as an important diagnostic clinical parameter in guttate psoriasis).

In the intensively treated state, the whitish scaling is completely absent. Depending on the intensity of the pre-treatment, 0.1-1.5 cm large red spots, flat papules or plaques are found.

Furthermore, guttate psoriasis in the eruptive stage often shows a positive Köbner phenomenon, which is detectable as a linear pattern even later.

Psoriasis guttata can occur as an initial manifestation (especially in children) or in the context of triggered relapsing activity even in pre-existing psoriasis vulgaris.

Clinically, streptococcal infections (tonsils) or other acute infections(urinary tract infections) are to be excluded as trigger factors(ASL titers).

ASL frequently elevated, further elevation of ESR and CRP. Possibly neutrophilic leukocytosis.

Superficial interstitial mixed-cell dermatitis with low acanthosis, exocytosis, spongiosis, focal parakeratosis and, depending on the degree of acuteity, also neutrophil abscesses in the upper epithelial layers (Munro microabscess)

See below Psoriasis vulgaris. It is important to search for and rehabilitate a possible focal lesion.

The question of tonsillectomy cannot be answered unequivocally. In a larger study of 545 patients, the evidence for the benefit of tonsillectomy was present but low. It is recommended that this be decided on a case-by-case basis. Tonsillectomy is recommended when there is a clear association between relapse activity of psoriasis and activity of chronic tonsillitis.

Guttate psoriasis shows a good response to dithranol local therapy, which is considered the therapy of first choice (see Dithranol scheme, see below psoriasis vulgaris).

In the case of initial manifestation in children, the prognosis is favourable with spontaneous healing or healing with sufficient local therapy within a few weeks. In 30-70% of the cases the course is chronic.

1. Asumalahti K et al (2003) Genetic analysis of PSORS1 distinguishes guttate psoriasis and palmoplantar pustulosis. J Invest Dermatol 120: 627-632
2. Chalmers RR et al (2001) A systematic review of treatments for guttate psoriasis. Br J Dermatol 145: 891-894
3. Diluvio L et al (2006) Identical TCR beta-chain rearrangements in streptococcal angina and skin lesions of patients with psoriasis vulgaris. The Journal of Immunology 176: 7104-7111
4. Garty B et al (2001) Guttate psoriasis following Kawasaki disease. Pediatric Dermatol 18: 507-508
5. Ito T et al (2000) Psoriasis guttate acuta triggered by varicella zoster virus infection. Eur J Dermatol 10: 226-227
6. Owen CM et al (2001) A systematic review of antistreptococcal interventions for guttate and chronic plaque psoriasis. Br J Dermatol 145: 886-890
7. Rachakonda TA et al (2015) Effect of tonsillectomy on psoriasis. A systematic review. J Am Acad Dermatol 72: 261-273
8. Sandhu K et al (2003) Role of Pityrosporum ovale in guttate psoriasis.J Dermatol 30: 252-254
9. Shin MS et al (2013) New Onset Guttate Psoriasis Following Pandemic H1N1 Influenza Vaccination. Ann Dermatol 25:489-492