Guttate psoriasis is a distinctive acute skin eruption characterised by small drop-like, salmon-pink papules which usually have a fine scale. This variant primarily occurs on the trunk and the proximal extremities but it may have a more generalised distribution. A history of an upper respiratory infection secondary to group A beta haemolytic streptococci often precedes the eruption by 2-3 weeks. Guttate psoriasis may be chronic and unrelated to streptococcal infection.
In most cases there is a history of an antecedent streptococcal infection, usually of the upper respiratory tract, such as pharyngitis or tonsillitis, 2-3 weeks prior to the eruption.
There may be a positive family history of psoriasis.
The onset of the skin lesions is often acute, with multiple papules erupting on the trunk and the proximal extremities.
Lesions may sometimes spread to involve the face, the ears and the scalp.
The palms and the soles are rarely affected.
The rash is often associated with mild itching.
Like other forms of psoriasis, guttate psoriasis tends to improve during the summer and worsen during the winter.
Examination of the skin reveals characteristic lesions consisting of multiple, discrete drop-like salmon-pink papules. A fine scale may be seen on established lesions.
Nail changes characteristic of chronic psoriasis (eg, pits, ridges and the oil-drop sign) are usually absent.
