A 16-year-old female seeks treatment for an extensive eruption involving her trunk and extremities that developed 3 weeks earlier. On questioning, the patient states that the rash was preceded by a slight fever and a sore throat. She was taking no medication when the rash began and has no history of allergies or cold sores. She received oral steroids from another clinician, but the medication had no effect on the rash. Examination reveals a diffuse erythematous eruption with minimal scale, sparing the palms, soles, and face.
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Psoriasis is an inflammatory disorder linked to immune dysregulation that affects approximately 3% of adults in the United States.1 Guttate psoriasis is a less commonly encountered clinical variant that occurs classically in children and adolescents, often following beta-hemolytic streptococcal infections.2 The name is derived from the Greek word gutta, meaning droplet, and patients frequently present with scores of erythematous to salmon-colored patches ranging in size from 2 to 15 mm.
The prognosis for guttate psoriasis is usually good, and many cases resolve within several months, unlike plaque psoriasis.3 Phototherapy and topical steroid medications are the mainstays of therapy. Penicillin, in select cases, may hasten resolution, as may tonsillectomy,4,5 strengthening the presence of a causal relationship to streptococcal infection.
Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.
- Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70:512-516.
- England RJ, Strachan DR, Knight LC. Streptococcal tonsillitis and its association with psoriasis: a review. Clin Otolaryngol Allied Sci. 1997;22:532-535.
- Chalmers RJ, O’Sullivan T, Owen CM, Griffiths CE. A systematic review of treatments for guttate psoriasis. Br J Dermatol. 2001;145:891-894.
- Silverberg NB. Pediatric psoriasis: an update. Ther Clin Risk Manag. 2009;5:849-856.
- Wilson JK, Al-Suwaidan SN, Krowchuk D, Feldman SR. Treatment of psoriasis in children: is there a role for antibiotic therapy and tonsillectomy? Pediatr Dermatol. 2003;20:11-15.