Guttate psoriasis (eruptive psoriasis) is most common in children and young adults. It develops acutely in individuals without psoriasis or in those with chronic plaque psoriasis. Patients present with many small erythematous, scaling papules, frequently after upper respiratory tract infection with β-hemolytic streptococci. The differential diagnosis should include pityriasis rosea and secondary syphilis. Pustular psoriasis is another variant. Patients may have disease localized to the palms and soles, or the disease may be generalized. Regardless of the extent of disease, the skin is erythematous with pustules and variable scale. Localized to the palms and soles, it is easily confused with. | Chapter 053. Eczema and Dermatitis Part 7 Guttate psoriasis eruptive psoriasis is most common in children and young adults. It develops acutely in individuals without psoriasis or in those with chronic plaque psoriasis. Patients present with many small erythematous scaling papules frequently after upper respiratory tract infection with 0-hemolytic streptococci. The differential diagnosis should include pityriasis rosea and secondary syphilis. Pustular psoriasis is another variant. Patients may have disease localized to the palms and soles or the disease may be generalized. Regardless of the extent of disease the skin is erythematous with pustules and variable scale. Localized to the palms and soles it is easily confused with eczema. When generalized episodes are characterized by fever 39 -40 C lasting several days an accompanying generalized eruption of sterile pustules and a background of intense erythema patients may become erythrodermic. Episodes of fever and pustules are recurrent. Local irritants pregnancy medications infections and systemic glucocorticoid withdrawal can precipitate this form of psoriasis. Oral retinoids are the treatment of choice in nonpregnant patients. About half of all patients with psoriasis have fingernail involvement appearing as punctate pitting onycholysis nail thickening or subungual hyperkeratosis. About 5-10 of patients with psoriasis have associated arthralgias and these are most often found in patients with fingernail involvement. Although some have the coincident occurrence of classic rheumatoid arthritis Chap. 314 many have psoriatic arthritis that falls into one of three types 1 asymmetric inflammatory arthritis most commonly involving the distal and proximal interphalangeal joints and less commonly the knees hips ankles and wrists 2 a seronegative rheumatoid arthritis-like disease a significant portion of these patients go on to develop a severe destructive arthritis or 3 disease limited to the spine psoriatic spondylitis .
