Life with Guttate Psoriasis

I was in elementary school when I first broke out in small, circular red patches on my legs. I can’t remember if an infection preceded these patches, but it’s likely. What I can remember is the overwhelming embarrassment I felt. I didn’t hear the term “guttate psoriasis” until my teens, after I started seeing a Dermatologist and had a biopsy done. I’m part of the 10-20% of psoriasis sufferers that have teardrop shaped patches spread across my body, as opposed to the larger, more typical plaques of psoriasis Vulgaris (the most common form). These teardrop patches usually flake less than their plaque counterparts, and for many people they do eventually go away. I am obviously not ‘many people’ though, and there are a few things I’ve found over the years that sets living with guttate psoriasis apart from plaque psoriasis.

We’re more likely to be triggered by infection

Streptococcal (strep throat) infections, tonsillitis, and other upper respiratory infections are among the most common triggers for acute guttate psoriasis. Streptococcus pyogenes (the bacterial culprit behind strep throat) can survive asymptomatically in about 20% of people, and there are a handful of studies that have shown removing the tonsils can significantly improve (or clear) guttate psoriasis in some patients (I may or may not have asked my doctor for a “therapeutic tonsillectomy” when I first learned of this research. He did not oblige me).  Other infections, like fungal and viral, can also trigger your first flare, or make the existing condition worse.

We’re more likely to be triggered by drugs

Research suggests that we’re more likely to have drug-induced or drug aggravated psoriasis. Anti-malarials, beta blockers, lithium, and NSAIDs (including aspirin, ibuprofen, and naproxen) may all cause us more grievance than our plaque counterparts. I can personally attest to the antimalarials being an issue! Guttate psoriasis may even be triggered by taking biologics, and in one clinical case, after an injection of ecstasy.

Our misdiagnoses are different

While flaking plaques on the elbows and knees may be a telltale sign of plaque psoriasis, guttate psoriasis may mystify your doctor. I was misdiagnosed with ringworm for many years (and I know many who can relate!). Guttate psoriasis can also resemble seborrhea, nummular eczema, contact dermatitis, tinea versicolor, or even hives. In short, there are many dermatological conditions that look similar, and the best advice is to get a referral to a Dermatologist and get a biopsy for a conclusive diagnosis.

We give different excuses

You’ve probably heard of plaque psoriasis sufferers passing off their symptoms as eczema or dry skin, especially because that’s often more expedient than explaining what psoriasis is. But these excuses don’t work as well for angry red spots! Instead, in the spring and summer I’ll sometimes pass them off as bug bites (which is by far and away what most people assume they are, especially in Canada). Mine are too big to be mistaken for hives, but for those with tiny red spots, hives or contact dermatitis is a common excuse. Of course, as a patient advocate I try to educate whenever possible, but sometimes I just don’t have the energy!

Topicals are not an easy solution

While topicals are one of the preferred treatments for guttate, they are often impractical for us. Imagine the frustration of having to apply topical cream to your plaques, twice every day. Now imagine your plaques fractured into 200 individual spots spread all over your body. Did I put cream on that spot already? Trying to use Q-tips to apply it to your back using the mirror (I always go the wrong way), always a struggle. It’s also difficult to apply steroid creams to only the affected area, which is the recommendation. For that reason, surrounding skin can often be collateral damage of thinning. If you have widespread guttate psoriasis and topicals are becoming impractical, talk to your Dermatologist about systemic/biologic or light therapy options.

We determine severity differently

A common way to assess the severity of psoriasis is to use PASI (Psoriasis Area Severity Index). PASI assesses the redness of plaques, thickness, and degree of scaling, but also the percentage of body coverage. When dealing with large plaques in focused areas, this assessment is easy, but how does one calculate the “total surface area” of (possibly) hundreds of small circles? If there’s a mathematical algorithm to do so, I don’t know of it! Instead, Doctors look at how many body segments are affected (scalp, trunk, arms, and legs), how prevalent your spots are in those areas, and how angry they look?

What about you? Do you find your guttate psoriasis presents unique challenges?