Thursday, June 11, 2009
If you have been suffering from sore throat recently, then watch out for any signs of psoriasis flare-ups in the next few weeks. Almost 80 percent of guttate psoriasis onset is triggered by streptococcal (or strep) bacteria, which causes sore throats.
Guttate Psoriasis' Clinical Apperance
In its clinical manifestation, guttate psoriasis may make you look like you had red polka dots of varying sizes all over your body. The Latin word, gutta, means ‘drop,’ hence, the description of droplike, or raindrop-like papules can often be found in books.
If you are more familiar with plaque psoriasis, you would most likely not recognize this condition as psoriasis from a distance. The red-colored spots may be mistaken for chicken pox, because the diameter of the lesions usually ranges between 0.1 and 1.0 centimeter. While the identifiable flakes are also present in guttate psoriasis, it is not as scaly as those in plaque psoriasis.
Guttate psoriasis is usually common among children and young adults. It could be the early manifestation of psoriasis or it could signify a looming acute flare-up of a pre-existing psoriatic condition, usually the plaque-type. If you have plaque psoriasis, then it is easier to diagnose guttate psoriasis. However, if it is the first time that this disease manifested, it may not be immediately diagnosed as psoriasis. Other conditions, such as pityriasis rosea and secondary syphilis, may be suspected. Family history and lab tests to confirm strep infection will be helpful in early diagnosis of guttate psoriasis.
Association of Strep Infection with Psoriasis
The immune system becomes overactive when there is streptococcal throat infection. It was in 1916 when Winfield made an observation that streptococcal infection is associated with psoriasis. The infection activates T-cells at various spots in the skin. These T-cells, which can penetrate into the skin, may mistakenly recognize certain foreign substances in the skin as part of the infection and proceed to attack them.
Some carbohydrates or keratins possess chemical identifiers similar to bacterial antigens. In a sense, the body is confused and over-reacts, believing the strep invasion is bigger than it actually is. As a result, some patients go on to develop the chronic condition of plaque psoriasis.
Guttate Psoriasis Treatment
In most cases, guttate psoriasis is resolved if the underlying infection is treated. It may take a few weeks, or months, for guttate psoriasis to be completely gone. In some patients, the condition does not recur. But in others, it temporarily worsens a preexisting psoriasis (which eventually recedes to its previous state) or it opens the possibility of minor recurrences of psoriasis.
To address strep infection, doctors often recommend a 10- to 14-day antibiotic therapy. Natural sunlight or ultraviolet B therapy may also be prescribed if there is no improvement after a month since the outbreak of guttate psoriasis, or if you have preexisting plaque psoriasis. If the doctor does not prescribe antibiotics, you may want to make sure it is not needed — since you do have the strep infection — or ask for a second opinion.
Photo credit: Foxtongue (flickr.com)
Bergstrom, K. and Kimball, A. (2005). 100 Questions & Answers about Psoriasis. (Sudbury, MA: Jones and Bartlett Publishers).
Bos, J. (2004). Skin Immune System, Third Ed. (Boca Raton: CRC Press).
Camisa, C. (2004). Handbook of Psoriasis, Second Ed. (Malden: Blackwell Publishing).