A child presents with few small erythematous papules with minimal scaling on trunk and arms. His parents report a recent sorethroat. What is the likely diagnosis?
Answer: Guttate Psoriasis
Expl:
Introduction
- It is derived from the Latin word gutta, meaning drop (Guttate psoriasis is a type of psoriasis in which there are small, separated teardrops like lesions)
- The role of infection (tonsillar Streptococcus pyogenes infection) in precipitating guttate psoriasis is well known. Infection often precedes the eruption by 2-3 weeks.
Clinical feature
- It is particularly common in children
- Common sites are the arms, legs, and torso.
- Acute onset of small, 1-10 mm diameter, droplike, erythematous papules, usually with a fine scale (generally the classical silvery scale is not easily seen)
How does streptococcus cause Guttate psoriasis ?
- Still under debate.
- It has been suggested that streptococcal M protein may be similar to keratin in skin and hence leads to a molecular mimicry immunological response towards keratinocytes instead of the original streptococcus. This cross- reactivity between streptococcal antigens and keratinocyte components could explain the initiation of a disease process.
Treatment
- There is no firm consensus on specific treatment algorithms
- Antibiotics to eradicate streptococcus are often started. Eg: ß -lactum antibiotics, Erythromycin,rifampicin etc
Prognosis
- Episodes may recur, especially those due to pharyngeal carriage of streptococci
- Generally, the disease is self-limiting, but a certain percentage of cases progress to chronic plaque psoriasis.
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