Guttate Psoriasis

Medically Reviewed by Stephanie S. Gardner, MD on October 07, 2024
Written by Kristen Fischer
6 min read

Guttate psoriasis is a type of psoriasis that shows up on your skin as red, purple, or brown, scaly, teardrop-shaped spots. Many people experience it as a child or young adult, usually after an infection. The itchy spots tend to go away on their own.

That’s not to say guttate psoriasis isn’t serious because about one-third of people who get it will go on to develop a more chronic form of psoriasis, which is an autoimmune disease that causes your body to attack your own cells.

Guttate psoriasis vs. plaque psoriasis

Guttate psoriasis isn’t as common as plaque psoriasis, which is the most common type of psoriasis that lasts throughout a person’s life.

Plaque psoriasis shows up as large, scaly patches on your skin. The patches form large plaques; guttate psoriasis forms small red or pink patches that don’t always have scales. The patches usually have healthy skin around them.

Plaque psoriasis happens at any age, usually between 20 and 30 years old or 50 to 60 years old; guttate psoriasis happens in children and young adults under 30. A bacterial infection like strep throat usually causes guttate psoriasis, while plaque psoriasis can occur as a result of many triggers including genetics.

If you or your child has guttate psoriasis, it’s most likely to show up on the torso, arms, or legs. Plaque psoriasis usually happens on the elbows, knees, scalp, ears, and lower back. Guttate psoriasis doesn’t appear on your palms, the soles of your feet, or nails like other forms of psoriasis. 

Symptoms of guttate psoriasis include:

Patches. Round or teardrop-shaped pink or red patches will appear on lighter skin tones, while darker skin tones may notice purple or brown spots. The patches are usually between 2 and 10 millimeters wide. You may notice dry skin scales that peel off the red patches. The patches show up on the arms, legs, and torso area.

Itching. The patches of skin will itch and be irritated.

How long does guttate psoriasis last?

In most cases, an outbreak of guttate psoriasis lasts two to three weeks. But your doctor may want to treat your symptoms and help prevent other infections in your body.

Is guttate psoriasis contagious?

No. Guttate psoriasis can’t spread to others. The bacterial infections that can cause this type of psoriasis, however, can be transmitted to other people.

An outbreak is usually triggered by a bacterial infection — typically streptococcus (strep throat). It sets off an immune system reaction that causes the spots on your skin.

In some cases, guttate psoriasis is genetic. If someone in your family has it, your chances of getting it go up.

Other triggers include:

  • Upper respiratory infections
  • Sinus infections
  • Flu
  • Tonsillitis
  • Stress
  • Cuts, burns, or bites on your skin
  • Some drugs you take (antimalarials and beta-blockers)
  • Alcohol
  • Sunburn 

There are three stages of guttate psoriasis, based on severity:

  • Mild. Only a few spots cover about 3% of your skin.
  • Moderate. Lesions cover about 3%-10% of your skin.
  • Severe. Lesions cover 10% or more of your body and could cover your entire body.

The stage can also be based on how much the psoriasis interferes with your daily life and activities. For example, psoriasis on your face or scalp can affect only 2%-3% of your total body surface area, but it could be classified as severe because it affects your appearance and livelihood. Psoriasis on your hands might only cover 2% total body surface area, but could affect your livelihood if you work with your hands. In that case it would be classified as moderate to severe.

There are two main causes that have been linked to psoriasis:

  • Bacterial infections. Group A streptococcus, the bacteria that causes strep throat, is usually the culprit behind cases of guttate psoriasis. 
  • Genetics. Psoriasis is strongly associated with at least two genes that the medical community knows about. If you have family members with any form of psoriasis, especially if it’s your biological parents, you may be more likely to develop psoriasis. If you have two parents with psoriasis, that raises your chances even more.

Guttate psoriasis risk factors

People may be more at risk for guttate psoriasis if they have an autoimmune disorder like rheumatoid arthritis or are undergoing chemotherapy. Smoking tobacco also raises the risk for psoriasis and can make it more severe.

How common is it?

The National Psoriasis Foundation reports that about 8% of people who have psoriasis will develop guttate psoriasis. About 2% of all cases of psoriasis are guttate psoriasis, according to another report.

Your doctor will want to know your medical history, especially what kinds of medications you may be taking. They’ll look at your skin. Usually, a physical exam gives your doctor enough information to diagnose or rule out guttate psoriasis.

If they need more information, your doctor may take a blood sample or a throat culture to check for strep. It’s also common for doctors to perform a skin biopsy when they want to know for sure what you have.

A variety of treatments exist if you or your child have guttate psoriasis. Your doctor or health care professional will be able to advise you which solution is best for your case, based on the severity.

Mild guttate psoriasis 

You can treat mild cases of guttate psoriasis with:

  • Over-the-counter cortisone cream for itching and swelling
  • Dandruff shampoo for your scalp
  • Lotions with coal tar to soothe your skin
  • Moisturizers
  • Prescription medicines that contain vitamin A

Moderate to severe guttate psoriasis

Your doctor may recommend any of these treatments for severe guttate psoriasis:

  • Corticosteroids
  • Biologics like guselkumab (Tremfya) and ixekizumab (Taltz)
  • Apremilast (Otezla)
  • Deucravacitib (Sotyktu)
  • Methotrexate
  • Phototherapy. Also known as light therapy, this is another option. Your doctor will shine ultraviolet light onto your skin during this treatment. They may also give you medication to make your skin react more quickly to light. Sometimes, just going out in the sunshine can help.

Biologics are effective for plaque psoriasis, but they haven’t been studied as well in cases of guttate psoriasis. Biologics are best for about 40% of guttate psoriasis patches that turn into plaque psoriasis, some reports say.

Guttate psoriasis isn’t contagious, so it can’t spread. Strep throat and respiratory infections that can lead to it, however, are contagious.

Guttate psoriasis is usually temporary and will clear up on its own.  Some people may experience guttate psoriasis more than once, but that doesn’t mean it will lead to chronic plaque psoriasis.

If you do go on to develop psoriasis, there are resources to help you. It’s good to know what to expect if you have psoriasis, as it can affect your physical and mental health and your entire life.

Symptoms of psoriasis can flare up from time to time, impacting your daily life. Psoriasis increases your risk for type 2 diabetes, cardiovascular (heart) disease, depression, and psoriatic arthritis (PsA).

In addition to the risk for developing other health ailments, guttate psoriasis can affect your quality of life and lead to psychosocial effects, at least as long as it lasts. It can also cause dark skin color to change.

In many cases, guttate psoriasis is a temporary condition that usually occurs after a child has an infection such as strep throat. It can turn into chronic plaque psoriasis in some cases, which will require long-term treatment.

Is guttate psoriasis temporary? 

Guttate psoriasis can emerge temporarily and often goes away on its own. But it’s good to get an accurate diagnosis so you can treat it, if necessary. Some people may experience guttate psoriasis more than once, but that doesn’t mean it will lead to chronic plaque psoriasis, though it can.

How can I tell if I, or my child, has guttate psoriasis?

Go to your local health care center. A doctor can usually tell if the rash is guttate psoriasis just by looking at it, but they may suggest a strep throat test or blood work. 

Will I have to go on long-term medication for guttate psoriasis?

Most cases respond well to topical medications and phototherapy. If it doesn’t seem to clear up, talk to your dermatologist.

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