From the Guidelines
Guttate psoriasis treatment should prioritize narrowband UVB phototherapy, as it has been shown to be highly effective in achieving clearance within 2 weeks and has a higher remission rate of 38% after 1 year, compared to broadband UVB 1.
Treatment Overview
Guttate psoriasis treatment typically involves a combination of topical therapies, phototherapy, and addressing the underlying trigger. The goal of treatment is to reduce symptoms, improve quality of life, and prevent long-term complications.
First-Line Treatment
First-line treatment includes:
- Topical corticosteroids like betamethasone valerate 0.1% or triamcinolone 0.1% applied twice daily to affected areas for 2-4 weeks
- Calcipotriene (a vitamin D analog) 0.005% ointment can be used alone or combined with steroids
Phototherapy
For widespread eruptions, narrowband UVB phototherapy administered 2-3 times weekly for 6-12 weeks is highly effective. The dosing and duration of treatment should be according to the guidelines outlined in the study 1.
Addressing Underlying Triggers
Since guttate psoriasis often follows streptococcal throat infections, treating the underlying infection with antibiotics like penicillin V 500mg four times daily for 10 days may help if the infection is still active.
Additional Considerations
Moisturizers should be applied regularly to reduce scaling and itching. Most cases of guttate psoriasis resolve within 3-4 months with appropriate treatment, though some patients may develop chronic plaque psoriasis later. The condition responds well to treatment because the lesions are thin and numerous, allowing for better medication penetration and light therapy effectiveness.
Systemic Treatment
In some cases, systemic treatment with methotrexate or acitretin may be necessary, especially for moderate to severe psoriasis. However, the use of these medications should be carefully considered and monitored due to potential side effects and interactions 1.
From the Research
Guttate Psoriasis Treatment Options
- Topical corticosteroids and calcipotriol creams have been found to be effective in treating guttate psoriasis, as evidenced by studies 2, 3
- Phototherapy, particularly narrowband ultraviolet B (UVB), has been shown to be an effective treatment for guttate psoriasis, with robust evidence supporting its use 2, 4
- Systemic therapies, including traditional immunosuppressants, antibiotics, retinoids, and biologics, may be considered for patients with moderate-to-severe guttate psoriasis who fail to respond to topical therapies and phototherapy 2, 5, 4
- Avoiding triggering and exacerbating factors, such as streptococcal infections, is also important in managing guttate psoriasis 6, 5, 4
Treatment Algorithms
- A proposed treatment algorithm suggests using topical corticosteroids and calcipotriol cream, in combination with phototherapy, as first-line therapy 2
- Supportive therapy with antibiotics may be recommended if applicable 2, 4
- Second-line therapy may include methotrexate or cyclosporine, while biologics can be used as third-line treatment for severe and refractory cases 2
- For mild cases, topical corticosteroids alone or in combination with other topical agents may be sufficient 5
- For moderate-to-severe cases, ultraviolet phototherapy may be the first-line therapy, as it is more practical than topical therapy when treating widespread or numerous small lesions 5
Efficacy of Different Treatments
- Studies have shown that betamethasone dipropionate 0.05% cream plus ultraviolet B (UVB) radiation, with or without additional penicillin therapy, can be effective in treating guttate psoriasis 4
- Oral psoralen plus ultraviolet A (PUVA) therapy and systemic retinoids therapy have also been found to be effective in treating generalized psoriasis vulgaris, although PUVA therapy may cause fewer side effects than systemic retinoids 4
- A new two-compound product containing calcipotriol and betamethasone dipropionate has been shown to be effective and safe in treating guttate psoriasis, with no lesional/perilesional adverse reactions during application and normal blood examinations 3