Which clinical type of psoriasis is characterized by the sudden onset of small (< 1 cm), discrete, erythematous papules covering the entire body, often following a streptococcal infection?

Explanation

## Guttate Psoriasis **Key Point:** Guttate psoriasis is a distinct clinical variant characterized by: - **Sudden onset** of numerous small papules (1–10 mm diameter, "guttate" = drop-like) - **Widespread distribution** across the trunk and extremities - **Preceding streptococcal infection** — typically 2–3 weeks after pharyngitis (Group A Streptococcus) - **High spontaneous remission rate** — up to 80% resolve within months ### Epidemiology & Triggers - Most common in **children and young adults** (peak age 10–25 years) - Can occur as the first presentation of psoriasis or in patients with chronic plaque psoriasis - **Streptococcal pharyngitis** is the strongest identifiable trigger (anti-streptococcal antibodies often elevated) ### Differentiation from Other Types | Feature | Guttate | Pustular | Erythrodermic | Inverse | |---------|---------|----------|---------------|----------| | **Lesion size** | 1–10 mm (small) | Pustules on erythematous base | Confluent erythema | Large plaques | | **Onset** | Acute, sudden | Acute or chronic | Acute, severe | Insidious | | **Trigger** | Streptococcal infection | Drugs, infection, pregnancy | Severe stress, drugs | Friction, moisture | | **Distribution** | Trunk, extremities | Palms, soles, flexures | Generalized (>80% BSA) | Flexural areas | | **Systemic symptoms** | Usually absent | Fever, malaise (severe) | Fever, chills, systemic | Minimal | **High-Yield:** The **streptococcal trigger** is the key distinguishing feature of guttate psoriasis. NEET PG frequently asks about this association. Always consider throat culture or anti-streptococcal serology (ASO titre, anti-DNase B) in suspected guttate psoriasis. **Clinical Pearl:** Guttate psoriasis has the best prognosis among psoriasis types — many patients achieve complete remission. However, some may progress to chronic plaque psoriasis. **Mnemonic: GUTTATE** = **G**roup A **Strep**, **U**nder 1 cm, **T**runk + extremities, **T**ransient course, **A**cute onset, **T**ypically young, **E**ruptive [cite:Park 26e Ch 8]