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CASES 4A AND 4B: Guttate Psoriasis

CASES 4A AND 4B: Guttate Psoriasis

4A:Small, slightly pruritic, salmon pink papules with thick white scale have arisen over the past 5 days on the trunk and arms of a 24-year-old man. The patient has a history of very mild psoriasis vulgaris of the elbows, knees, and scalp; he denies streptococcal pharyngitis or other recent infections. Guttate psoriasis is diagnosed. (Case and photographs courtesy of Joe Monroe, PA-C.) 4B:The abrupt onset of a generalized exanthem of multiple small, scaly papules sends a 19-year-old woman for medical evaluation. The patient had a sore throat 2 weeks earlier. She uses no medications and has no allergies. Scattered, discrete, 0.2- to 1.0-cm, salmon pink, scaling papules involve most of the body symmetrically; the palms and soles are spared. All laboratory test results are normal except for an elevated antistreptolysin-O titer. The clinical picture and history suggest guttate psoriasis. (Case and photograph courtesy of Drs Tausif Zar and Claudia McClintock.) What strategies would you pursue in these patients?
A REVIEW OF THE OPTIONS Guttate psoriasis is characterized by teardrop-size pink papules that often develop in response to a streptococcal or other upper respiratory tract infection. The lesions are much smaller than those of psoriasis vulgaris; however, this usually shortlived condition can evolve into chronic psoriatic disease. Generally, guttate psoriasis clears quickly; when lesions are widespread, UV-B therapy may be recommended to accelerate clearing. Consider antibiotic therapy when the patient's throat culture is positive or when episodes of guttate psoriasis recur. Penicillin, cephalosporin, erythromycin, or rifampin can be used to eradicate group A β -hemolytic streptococci and, in turn, help treat guttate psoriasis. CASE 4A:
APPROACH AND OUTCOME UV-B therapy successfully cleared the guttate psoriasis in this 24-year-old man. CASE 4B:
APPROACH AND OUTCOME No treatment was offered; the patient recovered spontaneously in 1 month. There were no residual signs of papules; a second antistreptolysin- O titer indicated no infection.

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