More Than Skin Deep
5. This 18-year-old patient had multiple, erythematous papules and plaques with a fine scale over her face, neck, trunk, and lower legs. She noted that the eruption had developed after a sore throat 2 weeks earlier and that it was itchy.
Photos courtesy of David A. Boyd, MD
Diagnosis: Guttate psoriasis was diagnosed in this patient based on her history and physical exam, a throat culture that was positive for group A beta-hemolytic streptococci, and blood work that showed an elevated antistreptolysin O titer. Further confirmation was obtained via punch biopsy.
Guttate psoriasis is a fairly uncommon form of psoriasis, affecting approximately 2% of patients with psoriasis.1 It is characterized by the abrupt onset of pruritic, salmon-pink 1- to 10-mm droplike lesions with fine scale that may spread to the face, but spare the palms and soles. It’s uncommon for this sub-type of psoriasis to involve the nails.
Guttate psoriasis affects individuals younger than 30; there appears to be no gender predilection.2 The rash usually appears 2 to 3 weeks after an upper respiratory group A beta-hemolytic streptococci infection. Although less common, there have also been reports of guttate psoriasis associated with perianal streptococcal disease.2
1. Habif TP. Clinical Dermatology. 4th ed. St. Louis, Mo: Mosby; 2004;209-239
2. Honig PJ. Guttate psoriasis associated with perianal streptococcal disease. J Pediatr. 1988;113:1037-1039.
For more information, see “Teen with a diffuse erythematous, pruritic eruption.” J Fam Pract. 2011 January;60(1):37-39.
