Symptoms--Small Scaling Spots

Reviewed by: HU Medical Review Board | Last reviewed: July 2016.

For some people with psoriasis, instead of getting plaques that form on the skin, they experience small scaling spots.

How can psoriasis cause small scaling spots?

Small scaling spots are caused by a type of psoriasis called guttate psoriasis. Like other forms of psoriasis, guttate psoriasis is an autoimmune condition that causes symptoms on the skin called plaques. In plaque psoriasis, which is the most common form of the condition, the plaques are usually larger and are thickened, red, and covered with a layer of silvery scales1.

What is guttate psoriasis?

In guttate psoriasis, however, the plaques that appear are different than the ones caused by plaque psoriasis. Guttate psoriasis causes red or salmon-pink spots that are shaped like little teardrops or raindrops. The word guttate comes from the Latin word for drop. The spots are quite small; each is usually less than 10 millimeters wide. The spots are often covered with a very thin, fine layer of scale2.

People with the condition may have just a few spots on one part of the body, or they may have hundreds of these spots all over the body. The spots can occur anywhere on the skin but usually occur on the chest, stomach, back, arms, and legs. The scalp, ears, and face are also common locations for these spots, which are also called lesions. These lesions may often appear very quickly over a few days. The lesions are sometimes but not always itchy2.

How common are small scaling spots as a symptom of guttate psoriasis?

Guttate psoriasis affects about 10% of people who have psoriasis. It is the second most common form of the condition, after plaque psoriasis, which affects 80% to 90% of psoriasis patients1. Guttate psoriasis is more common among children and among adults younger than 30 years of age3. People who have had guttate psoriasis are slightly more likely to develop plaque psoriasis in the future. A person can have guttate psoriasis at the same time as having plaque psoriasis or some other form of psoriasis4.

What are the possible causes of small scaling spots?

Most people develop the small scaling spots of guttate psoriasis after they have had an infection. It can take up to a couple of weeks after the infection for the symptoms of guttate psoriasis to develop. Strep throat, an upper respiratory infection, is the most common trigger. Fungal and viral infections can also trigger an outbreak of guttate psoriasis1.

Other people develop guttate psoriasis after taking certain types of medications, such as2:

  • Beta-blockers
  • Lithium
  • Anti-malaria drugs
  • Nonsteroidal anti-inflammatory drugs, which include common painkillers such as aspirin or ibuprofen

What are treatment options for guttate psoriasis?

For some people, a flare up of guttate psoriasis lesions will go away after a few weeks or months without any treatment needed, but others need treatment for the symptoms. These may include2:

  • Prescription or over-the-counter topical medicines
  • Antibiotics to treat the infection that caused the flare up
  • Phototherapy
  • Vitamin D or Vitamin A analog medicines
  • Systemic medicines that affect the immune system, such as immunosuppressants or biologic therapies

Guttate psoriasis is unlike other types of psoriasis in that many people who have an outbreak never have another flare up, although some people will. Treating an infection, such as strep throat, with antibiotics as quickly as possible is the best way to prevent small scaling spots from forming3

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