From the Guidelines
Guttate psoriasis should be treated with narrow-band UVB phototherapy, which has been shown to be highly effective in achieving clearance and remission, with a remission rate of 38% after 1 year, as per the guidelines outlined in the Journal of the American Academy of Dermatology 1.
Treatment Overview
The treatment of guttate psoriasis typically involves a multi-faceted approach, including topical therapies, phototherapy, and in some cases, systemic medications.
- Topical corticosteroids, such as triamcinolone 0.1% cream or betamethasone valerate 0.1% ointment, can be used as first-line therapy for limited disease.
- For more widespread eruptions, narrow-band UVB phototherapy is recommended, administered 2-3 times weekly for 6-12 weeks, due to its high efficacy in achieving clearance and remission 1.
- Keeping the skin moisturized with emollients like petroleum jelly or ceramide-containing moisturizers applied after bathing helps maintain skin barrier function.
- If the outbreak is linked to a streptococcal infection, a course of antibiotics such as penicillin V 500mg four times daily for 10 days may be prescribed.
Phototherapy Details
The guidelines for phototherapy, specifically narrow-band UVB, are as follows:
- Initial dosing according to skin type (130-400 mJ/cm2) or MED (50% of MED).
- Subsequent dosage increase by 15-65 mJ/cm2 or 10% of initial MED.
- Treatment should be done 3-5 times a week.
- The response to narrow-band UVB is observed at 8-10 treatments, with an average of 15-20 treatments to achieve clearance, and a remission rate of 38% after 1 year 1.
Systemic Medications
For severe cases unresponsive to topical therapies and phototherapy, systemic medications like methotrexate (starting at 7.5-15mg weekly) or biologics might be considered, as outlined in the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies 1. During treatment, it's essential to avoid skin trauma, excessive sun exposure without protection, and alcohol consumption as these can worsen symptoms. Guttate psoriasis often responds well to treatment because it targets the overactive immune response causing rapid skin cell turnover, which manifests as the characteristic small, drop-shaped lesions. Many cases resolve completely within several weeks to months with appropriate treatment.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Guttate Psoriasis
- Topical corticosteroids and calcipotriol creams have been found to be effective in treating guttate psoriasis 2, 3
- Phototherapy, particularly narrowband ultraviolet B (UVB), has been shown to be a highly effective treatment option for guttate psoriasis 2, 3, 4
- Systemic therapies, such as methotrexate or cyclosporine, may be considered for patients with moderate-to-severe guttate psoriasis who fail to respond to phototherapy and topical therapies 2, 3
- Biologics can be used as a third-line treatment for severe and refractory guttate psoriasis 2
- Avoiding triggering and exacerbating factors, such as streptococcal infections, is also important in managing guttate psoriasis 3, 5
Treatment Algorithms
- A proposed treatment algorithm suggests using topical corticosteroids and calcipotriol cream, in combination with phototherapy, as first-line therapy 2
- Antibiotics may be used as supportive therapy if applicable 2
- Methotrexate or cyclosporine may be used as second-line therapy, and biologics as third-line therapy for severe and refractory cases 2