At a glance: Guttate psoriasis versus pityriasis lichenoides

Guttate psoriasis

Clinical features

  • Common in adolescents and young adults.
  • Often follows an acute streptococcal infection.
  • May occur in patients with or without history of psoriasis.
  • The patient may or may not have further problems with psoriasis.
  • Acute onset of rash.
  • Usually on the trunk and limbs.
  • Discrete, droplike (guttate), deep red papules often with silvery scale.

Management

  • May be self-limiting and usually resolves within four months.
  • Emollients, topical steroids or vitamin D analogue.
  • Ultraviolet light, if widespread and not practical to apply ointments. 

Pityriasis lichenoides

Clinical features

  • Affects children and young adults.
  • Small, widespread, pink papules that become reddish brown
  • In acute cases the rash may develop pink necrotic papules.
  • Post-inflammatory hyperpigmentation.
  • Most often occurs on trunk and inner aspect of the limbs.
  • Often symptomless but the patient may be feverish and unwell.

Management

  • The chronic form may last for months or years. The acute form usually settles after four to eight weeks.
  • Ultraviolet light.
  • Topical steroids if irritation. Oral antibiotics.
  • Topical immodulators such as tacrolimus.
  • For resistant cases systemic steroids, methotrexate, acetretin, dapsone or ciclosporin
  • Relapses often occur when treatment is discontinued
  • Regular follow up as malignant change has been reported. 

Contributed by Dr Jean Watkins, a GP in Ringwood, Hampshire

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