eMedicine Specialties > Dermatology > Papulosquamous Diseases

Psoriasis, Guttate: Follow-up

Author: Charles R Taylor, MD, Assistant Professor of Dermatology, Harvard Medical School; Director of Phototherapy Unit, Department of Dermatology, Massachusetts General Hospital
Contributor Information and Disclosures

Updated: Aug 3, 2009

Follow-up

Complications

  • Physicians should watch for possible hypersensitivity reactions to the above-mentioned antimicrobials, especially to penicillin. If hypersensitivity is suspected, the drug should be immediately discontinued. Patients who are sensitive to penicillin generally do well on erythromycin. Cephalosporins can also cover streptococci, but some cross-sensitivity with penicillins has been documented.
  • Areas of the skin that have been treated with high-potency topical steroids for long periods may show some atrophy, telangiectases, and hypopigmentation. Shifting to a preparation with a lower potency or to another treatment modality should be considered.
  • Patients on PUVA may experience a number of adverse effects, such as nausea and vomiting. These effects are sometimes remedied by taking psoralen pills after a meal. The psoralen-induced photosensitivity persists up to 24 hours after administration of the drug. Patients should be adequately informed about the need to wear protective lenses and to avoid sun exposure during this period.

Prognosis

  • Although guttate psoriasis often undergoes a short-lived course, it may also represent the initial stage of chronic plaque-type psoriasis.
    • The acute guttate form progresses into the chronic plaque form in an estimated 68% of patients.
    • In another study of 15 patients, the probability of an individual developing chronic psoriasis within 10 years of a single episode of acute guttate psoriasis was suggested to be about 1 in 3, although further studies with larger numbers of patients are needed to more accurately determine the risk.
  • Like other forms of psoriasis, guttate psoriasis has the tendency to improve during the summer and worsen during the winter. Once cleared, many patients who experience acute guttate psoriasis usually have limited or no evidence of psoriasis for prolonged periods.

Patient Education

  • Patients should be advised to minimize all forms of skin trauma, such as scratching or vigorous rubbing, which may lead to new psoriatic lesions on previously unaffected areas (Koebner phenomenon).
  • The association between streptococcal infections and guttate psoriasis cannot be overemphasized.
    • Early detection and treatment of such infections may prevent an acute flare of the skin disease. Samples should be obtained and cultured in patients who are susceptible and have a sore throat.
    • Some advocate early antibiotic therapy of any sore throat in individuals who are susceptible.
  • For excellent patient education resources, visit eMedicine's Psoriasis Center. Also, see eMedicine's patient education articles Guttate Psoriasis, What Is Psoriasis?, Types of Psoriasis, Understanding Psoriasis Medications, and Nail Psoriasis.

Miscellaneous

Medicolegal Pitfalls

  • For guttate psoriasis patients with atypical disease or for those who do not respond to therapy, alternative diagnoses should be considered.
  • A careful history should be taken to exclude certain drugs, such as beta-blockers and lithium, which may cause an eruption similar to that of guttate psoriasis.
  • Especially in patients with palmar and plantar lesions, serologic analysis should be performed to exclude secondary syphilis. Skin biopsy is probably the single most useful diagnostic test if the clinical diagnosis is not certain.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Elma Baron, MD, and Charles Taylor, MD, to the development and writing of this article.



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References
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References

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Further Reading

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Keywords

psoriasis, guttate psoriasis, perianal streptococcal infection, Streptococcus pyogenes, S pyogenes, upper respiratory infection

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Contributor Information and Disclosures

Author

Charles R Taylor, MD, Assistant Professor of Dermatology, Harvard Medical School; Director of Phototherapy Unit, Department of Dermatology, Massachusetts General Hospital
Charles R Taylor, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Laser Medicine and Surgery, Massachusetts Medical Society, New England Dermatological Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Mark G Lebwohl, MD, Chairman, Department of Dermatology, Mount Sinai School of Medicine
Mark G Lebwohl, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Abbott Laboratories Honoraria Consulting; Actelion Honoraria Consulting; Amgen Honoraria Consulting; Astellas Honoraria Consulting; Centocor Honoraria Consulting; DermiPsor Honoraria Consulting; Galderma  Consulting; Genentech Honoraria Consulting; Helix BioMedix Honoraria Consulting; Medicis Honoraria Investigator

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Christen M Mowad, MD, Associate Professor, Department of Dermatology, Geisinger Medical Center
Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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