Throat or perianal bacterial cultures to test for streptococcal infection might be performed, and elevated antistreptolysin O titre levels are common. Guttate psoriasis is essentially a clinical diagnosis. However, data from 1 small study suggest that approximately 33% of patients with guttate psoriasis might eventually develop chronic plaque psoriasis. Limited information is available about the long-term prognosis of individuals with first-manifestation guttate psoriasis. Guttate psoriasis is usually a self-limiting process, especially in children, with full resolution occurring within 12 to 16 weeks without treatment. 5, 6 Human leukocyte antigen genotypes might influence T-cell proliferation in response to streptococcal antigens (some of which have shown homology with human keratin) and thus might modulate the inflammatory response. It is postulated that the guttate eruption might result from an immune reaction to the streptococcal infection, usually in those with susceptible genotypes, particularly human leukocyte antigen–Cw*0602. The exact pathophysiologic correlation between guttate psoriasis and streptococcal infection is not fully understood. There have also been several case reports of guttate eruptions following streptococcal perianal dermatitis in children. 2, 3 Typically, the GAS infection precedes onset of the guttate eruption by 1 to 3 weeks, and the patient might relate a history of recent upper respiratory tract infection, pharyngitis, or tonsillitis. There is a well-established association between guttate psoriasis and antecedent or concurrent GAS infection. The word guttate is derived from the Latin word gutta, meaning “drop,” as the lesions can be likened to red drops splashed upon the skin. The rash is often asymptomatic, although some patients might report mild pruritus. The palms, soles, and face are usually spared. The distribution is primarily on the trunk and proximal extremities. A fine silvery scale is often present on more established lesions. Guttate psoriasis typically presents as an acute bilateral, symmetric eruption consisting of multiple, well-demarcated, salmon-pink to erythematous, round to oval papules ranging in size from 1 mm to 10 mm in diameter. Affected patients are much more likely to have a family history of psoriasis, and might report experiencing a stressful life event in close association with the guttate eruption. Guttate psoriasis might present as either the initial manifestation of psoriasis in individuals previously unaffected by psoriasis or as an acute exacerbation in individuals with pre-existing chronic plaque psoriasis. Guttate psoriasis is a distinct eruptive dermatosis that classically occurs in children and young adults following a group A β-hemolytic streptococcal (GAS) infection.
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