Childhood guttate psoriasis: an updated review

Area of Science:

• Dermatology
• Immunology
• Pediatrics

Background:

• Guttate psoriasis affects 0.5-2% of pediatric patients.
• It is characterized by sudden onset of small, scattered, tear-drop-shaped, scaly, erythematous, pruritic papules and plaques.
• A preceding streptococcal infection is often noted, and Koebner phenomenon is characteristic.

Purpose of the Study:

• To review the clinical manifestations, evaluation, diagnosis, and management of guttate psoriasis.
• To provide physicians with comprehensive information on this common pediatric skin condition.

Main Methods:

• A literature search was conducted in PubMed Clinical Queries using the key term "guttate psoriasis" in July 2023.
• The search included observational studies, clinical trials, and reviews published within the last 10 years.
• Information from the search was compiled for this review article.

Main Results:

• Guttate psoriasis typically appears abruptly on the trunk and extremities.
• Lesions may spontaneously remit in 3-4 months without scarring, recur intermittently, or progress to chronic plaque psoriasis in 40-50% of cases.
• Active treatment may be considered due to pruritus or cosmetic concerns, and given the high rates of persistence and progression.

Conclusions:

• Topical corticosteroids, often combined with agents like tazarotene or vitamin D analogues, are first-line for mild guttate psoriasis.
• Ultraviolet phototherapy is the preferred first-line treatment for moderate-to-severe cases due to practicality.
• Systemic therapies are reserved for severe cases unresponsive to topical treatments or phototherapy.