Childhood guttate psoriasis: an updated review

Abstract

Background Guttate psoriasis is common and affects 0.5–2% of individuals in the paediatric age group. This review aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis and proper management of guttate psoriasis. Methods A search was conducted in July 2023 in PubMed Clinical Queries using the key term “guttate psoriasis”. The search strategy included all observational studies, clinical trials and reviews published within the past 10 years. The information retrieved from the search was used in the compilation of the present article. Results Guttate psoriasis typically presents with an abrupt onset of numerous, small, scattered, tear-drop-shaped, scaly, erythematous, pruritic papules and plaques. Sites of predilection include the trunk and proximal extremities. There may be a history of preceding streptococcal infection. Koebner phenomenon is characteristic. Guttate psoriasis may spontaneously remit within 3–4 months with no residual scarring, may intermittently recur and, in 40–50% of cases, may persist and progress to chronic plaque psoriasis. Given the possibility for spontaneous remission within several months, active treatment may not be necessary except for cosmetic purposes or because of pruritus. On the other hand, given the high rates of persistence of guttate psoriasis and progression to chronic plaque psoriasis, some authors suggest active treatment of this condition. Conclusion Various treatment options are available for guttate psoriasis. Triggering and exacerbating factors should be avoided if possible. Topical corticosteroids alone or in combination with other topical agents (e.g. tazarotene and vitamin D analogues) are the most rapid and efficient treatment for guttate psoriasis and are therefore the first-line treatment for mild cases. Other topical therapies include vitamin D analogues, calcineurin inhibitors, anthralin, coal tar and tazarotene. Ultraviolet phototherapy is the first-line therapy for moderate-to-severe guttate psoriasis, as it is more practical than topical therapy when treating widespread or numerous small lesions. Systemic immunosuppressive and immunomodulatory therapies (e.g. methotrexate, cyclosporine, retinoids, fumaric acid esters and biologics) may be considered for patients with moderate-to-severe guttate psoriasis who fail to respond to phototherapy and topical therapies.

Recent Approaches for the Topical Treatment of Psoriasis Using Nanoparticles

“…A further type of the disease is the so-called “guttate psoriasis”, which is characterized by small, teardrop-shaped papules that often appear after a streptococcal throat infection. This type of PSO is more common in children and young adults [ 21 ]. Rare forms of the disease are the pustular and the erythrodermic PSO; the first can be characterized by the quick development of pus-filled blisters, while in the case of the other type, the entire skin surface becomes red and inflamed, which itches and burns intensely [ 22 ].…”

Functional Genomics and Insights into the Pathogenesis and Treatment of Psoriasis

“…AP1S3 has not been shown to have any association with plaque psoriasis, though findings have shown that loss of function mutations in AP1S3 increases the risk of pustular psoriasis independent of CARD14 and IL36RN, with Mahil et al showing that knock out of the gene causes autophagy in keratinocytes, mediating NF-κB activation [17]. Guttate psoriasis is an outlier among subtypes, caused by a preceding streptococcal infection and often clearing within 3-4 months without treatment, though with the potential to develop into plaque psoriasis [18]. Very little is known about the pathogenesis or potential genetic basis of erythrodermic psoriasis due to its rarity, accounting for only 1-2.25% of psoriatic patients [19].…”