Guttate psoriasis

[cbx]

Hi! This is my very first message ever on any message board! Hope I do it right!
My problem is guttate psoriasis which I guess "flares" whenever I get strep throat. It has happened twice in my life so far...now and about 6 years ago. Last time it took 6-8 months to completely clear and I thought Whew! I'm home free! But NOOOOO I got strep again in Feb of this year and have been suffering ever since. I must admit I have only gone to see a dermatologist twice this time..and he has given me a prescription for clobetasol propionate (sp) which seemed to really work great, at first...then after a few weeks using, it just kept the spots from being very sore and irritated, but did nothing to improve or make them go away. Wondering if I am stuck with this for life now..or will I get rid of it eventually...it is all over my torso mostly everywhere the sun don't shine... When I first got it back I had it everywhere: scalp, face, torso, arms, back legs butt... I guess I should find a nude beach somewhere and sunbath every day...??

anyone else out there in a similar situation??
CBX

[PJ Leary]

Hi cbx,

Welcome to the board. There are a lot of very nice and smart folks who post here ( like me!! ).

Strep is a common trigger for guttate p, I am the same. It is sometimes called a paint splatter effect, and is a clinical diagnosis for strep induced guttate p. You are right, it takes a long time to recove from a bad flare.

I am wondering if you are certain the strep is completely cleared up. Many of us do not get the normal sore throat, and so a grown out culture is required. Until the strep is under control, no medication I know of will help ( and I know most of them ).

It seems odd that a good derm would just give you the clobetasol and nothing else. It is a class 1, very potent steroid. You should be careful to use no more than 7 grams a day, and for no more than two weeks , with a two week rest. It can affect the adrenals in larger quantities.

There are less potent steroids you can use to wean yourself off of the stronger one, your dr can help with that. I often go from a class 1 to a class 3 to a class 5... That generally will work.

You may need to consider more aggressive therapy to get the flare under control. If your derm is not willing to help you use the steroids properly, I would think about finding a different derm. I have found that there are derms, and then there are good derms.

Good luck, let us know how we can help.

[cbx]

Thanks, PJ! You ARE very knowledgeable (sp??).
After reading some of these threads..I feel like a whiner...I guess there is alway someone worse off than yourself, eh?

I didn't mention that the derm did prescribe another lotion..I don't know the class or strength..just that it is weaker then the clobetasol. That lotion, again, just comforted, took the irritation and some of the itching away, but no real improvement. I will see him next week and if I am not satisfied will try another derm. I will mention about the strep too, maybe it isn't completely gone. Not sure if it is related but I seem to have been more sick this year in general...bad bad bad UTI in April and I have had cold sores right along (I know, the herpes simplex I virus--YUCK).
My immune system is out of wack I guess.

Anyway, nice to meet others whom I can commiserate with on some level!

CBX

[PJ Leary]

Hi cbx,

Please don't feel like a whiner, we don't think that way here, any of us. All with disease here are struggling at times, it is the nature of the disease. As I mentioned, right now I am having a good spell, and trying like heck to keep it!

FYI, any infection can trigger p, and UTI's are certainly included as a trigger for many women. I have needed to treat resistant strep for as long as six continuous months before I test negative. It is worth checking out.

[spot123]

hello pj and cbx,

i have had guttate for over 50 yrs now (i'm 57 now.) i have had remissions with summers in the northeast, tons of sunshine and medications. as years have gone by it seems my p. has gotten harder to get rid of. until i was maybe 30 summer that was enough plus baths and vasoline. (i lived with elbows, legs, and occas. spots here and there.) then (around late 60's) i went thru puva with derm near boston. long story short, in 3-4 months i was clear and stayed that way for 10 yrs. sunbeds and summers were enough to subdue the p. for the rest of the time. about 6 yrs ago i was in an accident that put me in bed for a yr - off and on. this started a series of progressive declines in terms of my disease - along with toothaches. so i went to the best hospital i found in boston, saw the best md's i could find info on (these appts took months and months to get,) and was put on a program of antibiotics, a topical steriod, plus devonex, vasoline and a uvb booth i bought for my home - thru a perscription. this is uvb broadband - and served it's purpose and now does not do the job. i went back to hospital last yr. met with 3 more experts in the p. field. this led me to using antibiotics and the mentioned creams and uvb narrow band light. this worked pretty good. thru the process of elimination i found the antibiotics - doxacyclin - more than the light- i think- seemed to be the best medicine. based on what you both mentioned, (as well as others) i wondered if you have had similar reactions - or results.

thanks - best of wishes to all,

as my 'best man' used to call me when we were kids,

spot123

[Marienne]

hello hello hello hello

oh hey man ! You can get better. I'd lost my faith and wanted
to die because the disease caught me unprepared and lingered all over my body for about five months, getting worse further down the line. Then i thought 'F**k it, i'm quittin uni+job for a while and i'm going to do something about my horrible state of health. I'd taken s**loads of antibiotics cause i couldnt find enough time to go to hospital and get my tonsils removed.
Finally i got it done and went on a holiday to a sunny country.
Spent a few days lying in the sun, swimming in the sea, reading books and partying hard. Well maybe at first some folk would point fingers at me going 'oh look it takes all sorts' and stuff like that but in no time at all i became the number one top girl !
He he. I've been clear for, let me think, about 3 months and fingers crossed. Oh i dont want to get it again *sob*sob*
I know it'll come back at some point but i' more careful now.
I know my triggers and i try to keep control over my life at all times. No one's telling me what to do, no institution is ruling
my life. I've just enrolled at uni but i know that if i fall ill again
i'm strong enough to tell them where to go. Same for my job.
I'll just pack up and go again. I'll go zen.
I'll chase the strep away. I'll eat less carbohydrates, more fish+veg+ gluten-free, i'll cut back on booze /that's a hard one/
and i'll b bloody positive. Now i know we can get over it, so that at least gives me a little hope. Arrrrgh. I'm so hyper. I'm lovin it.

Keep me posted on how things go, pals.

Love ya !

[cbx]

Hello,
I finally saw my Dermatologist the other day..for a brief visit. I haven't seen him since March or so..and I guess this Guttate p has mutated to regular plaque p. I didn't know it could do that. Well, what do I know..I just thought that since what I had was just red splotchy itchy spots that have just grown together to make bigger splotches it was still the same. When I think of plaque p I think of the photos they show in text books etc where the plaques look several layers deep etc...??
Oh well, I left with 3 prescriptions...2 I've used before and 1 new one--Elidel. I was instructed to alternate clobetasol and elidel daily till clear and then alternate with desonide...I think.?
Its been 3 days and so far so good. I am not quite so itchy and sore and the splotches are getting smoother, flatter ya know?

Marienne--you mentioned triggers..how do you know, or find out what they might be? Or since I don't have the guttate will it matter or are they different ...?


Til next time!
CBX

[airbooster]

Cbx WELCOME I was born with P and I am 58. I am going to tell you something the board is probably tired of seeing but it makes sense. Don't worry about what others think to thine own self be true and if folks can't see you for you thats their loss not yours. You are not a whiner you are among a family of follks that are in the same boat and all of us have P so post away and you are right PJ probably forgot more about P than a lot of folks will ever know but the rest of your new found family has very good advice as well so Welcome again. airbooster

[Marienne]

any more guttate-sufferers ? let us know how you're gettin on !

[LottieBay]

I have had a small patch of guttate above both ankles for years and years. They didn't bother me much and I pretty much ignored them. My knees and elbows would get small plaques from time to time, but I put moisturizer on everything and got by.
On November 1st last year I found myself in the hospital being treated for Acute Leukemia. My Dr. grinned and said "On the up side, the psoriasis will go away!" And by golly it did! Within three days of starting chemo there was no sign of p at all. I went through four rounds of chemo from Nov to April and my p stayed clear.
All of a sudden around the end of April it started coming back on my calves, then my arms, then my thighs, then my back and hips and scalp and hands. My GP and my Onc both gave me scrips for corticosteroid creams that helped keep the scaling down and turned the spots bright red. I felt good in remission from the leukemia, but I wasn't getting my strength and flexability back and I have continued to suffer extreme fatigue and have gained a tremendous amount of weight (from inactivity) causing my oncologist to scratch his head and go "HUM?"
He ordered a bone scan and x-rays of my hips and set me up with a rheumatologist. The appt is tomorrow. Since that appointment was made, though, I've started to feel much better. We have spent quite a bit of time out on the boat in the last few weeks in the sun and the spots on my arms are nearly gone. Just white spots remain. I have been taking Glucosamine and calcium and vitamin D for about a month and I have some flexability back and a little bit of a bounce to my step in the last few days.
A few weeks ago I was feeling pretty dispondant over the whole situation. I had come through a life threatening ordeal and should be getting back to normal and wasn't. Now I'm seeing a light at the end of the tunnel.

Margaret

[ryanbowers]

First time on this site and I have to say its great. I have picked up a lot of good information reading all of your posts.

I am currently diagnosed with Guttate psoriasis however I am not sure if thats exactly what I have...

Last June I had strep throat. 10 days after being being given the Pennacillin G shot ended up with a rash on my chest and trunk. Went to Derm was told told I had pityraisis roscea. Punch biopsy was done for guttate vs. PR. results said it looked more like PR. I used clobostatol of and on for 4 months. Lightened the spots but did not remove them. Did not itch or flake... Using a sunbooth cured it.

A little over two months later I caught strep throat again. 10 days after the Penacillin G shot bam its back. ( I had the Pen G shot a couple years ago without this happening) Its been three months now. Currently deployed on a ship to the Arabien gulf so sun treatment is not available.
Over the past three months I have been given two differant oral steroids, neither have produced any results. Also have used Lidex (fluocinonide .05) of and on. The Lidex removes about 90% but not all. A couple days after I quit using the Lidex it comes right back. The ships doc emailed pics to a derm on the beach who said it was Guttate and to use the Lidex 2 times a day, 7 days a week for 6 weeks and then send pics again if its still there. Said it was safe to use it for that extended a time.
?
I have read that Guttate is usually covered with silver scales ( not on mine), itches (never) and is usually on entire body ( only on trunk and chest- one or two on shoulders, upper arms). Also my family doesn't seem to have a history of psoriasis.
I have read and been told that Pityraisis Roscea can only occur once.
Does this sound like Guttate? Does anyone have any advice? How often do breakouts occur? Is there anything I can do to get rid of this, keep it from coming back?
My internet is almost non existing so if you would like to drop me an email with any advice I would appriciate it. I'll try back on here as soon as I can.
Thanks for all the help and the great site.
Ryan
ryan.bowers@cvw9.navy.mil

[jorel-1]

Ryan -

Guttate Psoriasis:
When you have guttate psoriasis, you will have small red dots (or drops) on your trunk, arms and legs. You may have some scales on these lesions. This form can flare suddenly following a strepto coccal infection or viral upper respiratory infection.

Plaque Psoriasis:
Plaque psoriasis is the most common type of psoriasis. Your skin will have raised, inflammed lesions. These lesions will be covered with silvery-white scales made up of dead skin cells. Doctors sometimes refer to it as "Psoriasis Vulgaris" (vulgaris means common). Your knees, elbows, scalp and trunk are places to look for this, but it can appear on any part of the body (I had it on several fingers). Plaque psoriasis will usually start off with red dot-like spots and may be very small, but in time will grow larger and get scaly. If you remove the scales, you will see tiny bleeding points below and that is referred to as "The Auspitz Sign."

Hope that helped some.

[MikeK]

First time on this site and I have to say its great. I have picked up a lot of good information reading all of your posts.

I am currently diagnosed with Guttate psoriasis however I am not sure if thats exactly what I have...

Last June I had strep throat. 10 days after being being given the Pennacillin G shot ended up with a rash on my chest and trunk. Went to Derm was told told I had pityraisis roscea. Punch biopsy was done for guttate vs. PR. results said it looked more like PR. I used clobostatol of and on for 4 months. Lightened the spots but did not remove them. Did not itch or flake... Using a sunbooth cured it.

A little over two months later I caught strep throat again. 10 days after the Penacillin G shot bam its back. ( I had the Pen G shot a couple years ago without this happening) Its been three months now. Currently deployed on a ship to the Arabien gulf so sun treatment is not available.
Over the past three months I have been given two differant oral steroids, neither have produced any results. Also have used Lidex (fluocinonide .05) of and on. The Lidex removes about 90% but not all. A couple days after I quit using the Lidex it comes right back. The ships doc emailed pics to a derm on the beach who said it was Guttate and to use the Lidex 2 times a day, 7 days a week for 6 weeks and then send pics again if its still there. Said it was safe to use it for that extended a time.
?
I have read that Guttate is usually covered with silver scales ( not on mine), itches (never) and is usually on entire body ( only on trunk and chest- one or two on shoulders, upper arms). Also my family doesn't seem to have a history of psoriasis.
I have read and been told that Pityraisis Roscea can only occur once.
Does this sound like Guttate? Does anyone have any advice? How often do breakouts occur? Is there anything I can do to get rid of this, keep it from coming back?
My internet is almost non existing so if you would like to drop me an email with any advice I would appriciate it. I'll try back on here as soon as I can.
Thanks for all the help and the great site.
Ryan
ryan.bowers@cvw9.navy.mil

Hi Ryan,

Welcome to the Board. Nice to meet you. I'm sorry to hear that you're going through such a rough time. Thank you very much for serving our country.

I figured that you'd get a better response if your introduction to use was told in a separate thread, so I posted a copy of it in a brand new thread. Here's a link to it: http://www.psoriasis.org/forum/showt...382#post162382.

In the meantime, here's some answers to your your questions. I'll also be sending you an e-mail.

Also have used Lidex (fluocinonide .05) of and on. The Lidex removes about 90% but not all. A couple days after I quit using the Lidex it comes right back. The ships doc emailed pics to a derm on the beach who said it was Guttate and to use the Lidex 2 times a day, 7 days a week for 6 weeks and then send pics again if its still there. Said it was safe to use it for that extended a time.?

According to the NPF's Steroid Classification Chart, Lidex comes in two different formulas. Lidex Cream/Gel/Ointment, 0.05% Fluocinonide is listed as a Class 2 or Potent Steroid and Lidex-E Cream, 0.05% Fluocinonide is lists as a Class 3 Upper Mid-Strength steroid. Steroids are grouped -- by strength -- into 7 different classes. Each class is assigned a number. The lower the number the stronger the steroid. As I mentioned, the Lidex Cream/Gel/Ointment, 0.05% Fluocinonide is a Class 2 or Potent steriod. Most derms limit the use of the Class 1 or Class 2 steroids to two weeks max (or two the weekends only) to prevent problems such as skin thinning. A Class 3 steroid, such as Lidex-E Cream, 0.05% Fluocinonide is still pretty strong and should only be used for limited periods of time. BTW, suddenly stopping any steroid can cause psoriasis to come back even worse then before. That's called a rebound effect. You might want to gradually stop using the Lidex. (I would go from twice a day to twice every other then and then to once every other day.) Here's a link to some additional information about Lidex: http://www.pdrhealth.com/drug_info/r.../lid1227.shtml. The Clobetasol that you initially used is a very powerful Class 1 Steroid that should only be used for very short peroids of time. Here's a link to some additional information about Clobetasol: http://www.pdrhealth.com/drug_info/r.../tem1431.shtml. And, here's a link to a thread that has a post that has a copy of the NPF's Steroid Classification Chart in it: http://www.psoriasis.org/forum/showthread.php?t=6255.

You also asked:

Does this sound like Guttate? Does anyone have any advice? How often do breakouts occur? Is there anything I can do to get rid of this, keep it from coming back?

According to the NPF's discussion of Guttate:

Guttate (GUH-tate) psoriasis looks like small, red, individual drops on the skin. These lesions generally appear on the trunk and limbs, and sometimes on the scalp. They usually are not as thick or as scale-covered as plaque psoriasis.

Source: http://www.psoriasis.org/facts/psoriasis/guttate.php.

Strep is a known trigger for guttate and it often clears from natural or artificial sunlight. Since your problem was brought on by strep throat and since using a sunbooth helped clear it, my non-medical guess is that you have guttate psoriasis. Unfortunately, there is no cure for psoriasis. If it seems to be getting worse, then it's possible that you might be asymptomatic for strep. More then a few people have posted here that either their psoriasis or their child's psoriasis was either triggered by or gets worse when they have strep. They've also posted that a psoriasis outbreak is often the only sign the they have strep because they don't have a sore throat or fever, etc. Here's a link to some previous discussions about psoriasis and strep: http://www.psoriasis.org/forum/showt...nce+strep+test and http://www.psoriasis.org/forum/showt...entation+strep.

Although itch and psoriasis usually go together, there are some people who have reported that their psoriasis doesn't itch.

I'm the only one in my family that has psoriasis.

I hope this helps. Good luck. Keep us posted and please don't be a stranger.

Mike

[hurley_gurlie17]

Hey, the only thing that i can reccomend is getting your tounsuls taken out. I havent been sick since my surgery. And im clear! And Enbrel is a life saver!!!!
Good Luck!!!!!

[Dulane]

If you haven't been reading the Slippery Elm threads and the Clearing threads where folks are using diet, alternative treatments and supplements, then it's time to start.

There are a bunch of us who are making very good progress, with no heavy drugs being used. Some folks cleared last year and the year before, and they are coming back to help us with support.

Some of these strings are very long, but worth the read. If you can get clear this way, you can stay clear too.

Remember, P comes from within, so fix the gut, and the skin will heal. Just warning you, this isn't usually a short term fix, it is a lifestyle change.

Dulane

[candipatti]

Hi CBX-
I was in similiar situation as you- the first Derm I saw- said- oh yeah this is gp and you must have / had strep so here's some col. cream, panthel for your face (less harsh) and some eurmythicin for your strep! and sent me on my way- said i'd be better in a month.
i did have a sore throat the week prior and was treated for sinus infection-
now last week when i saw my real derm. he was very agressive- put me on soriatiane, had pharm make me a compund and he's trying to get enbrel approved for me.
i've also soaked every night in either espom salt or sea salt and the last 3 nights been covering myself in vaseline WHILE still in the bath tub.
Every day my stuff looks better- strangely (except for my legs) it is healing in the order it appeared. I mean when I say I am covered I literally mean from my scalp to my toes to my finger tips!!!!
Keep positive- do what works for you- and I have to go get a root canal so I will write more later as I progress.

For the gentleman who stated he thought it might be PR- i was diagnosed with that as well but later found it was GP.

[bigpede]

this has been very difficult for him...he has tried everything from neosporin to pickle juice..as we are learning , so has everyone else.

Hi cbx,

Welcome to the board. There are a lot of very nice and smart folks who post here ( like me!! ).

Strep is a common trigger for guttate p, I am the same. It is sometimes called a paint splatter effect, and is a clinical diagnosis for strep induced guttate p. You are right, it takes a long time to recove from a bad flare.

I am wondering if you are certain the strep is completely cleared up. Many of us do not get the normal sore throat, and so a grown out culture is required. Until the strep is under control, no medication I know of will help ( and I know most of them ).

It seems odd that a good derm would just give you the clobetasol and nothing else. It is a class 1, very potent steroid. You should be careful to use no more than 7 grams a day, and for no more than two weeks , with a two week rest. It can affect the adrenals in larger quantities.

There are less potent steroids you can use to wean yourself off of the stronger one, your dr can help with that. I often go from a class 1 to a class 3 to a class 5... That generally will work.

You may need to consider more aggressive therapy to get the flare under control. If your derm is not willing to help you use the steroids properly, I would think about finding a different derm. I have found that there are derms, and then there are good derms.

Good luck, let us know how we can help.

[RichJ]

hi bigpede,
sorry i can't help much but sorry i can't help much but welcome to the p family. you have meet some of the wonderful people on here and will find alot of great info. welcome and nices to meet you.

have a good a night all

richard

[Carlismommy]

My 9 year old daughter suffered from strep throat and GP until we removed her tonsils out 2 months ago...Strep is a cause of GP- her tonsils were so big that a week after being on antibiotics she would get strep again(which would cause a major flair of psoriasis)....However, the only symptom of strep would be the outbreak of psorisasis. From Jan. of this year to the day she had them removed (march 10th) she was covered from head to toe with her psoriasis. Now, 2 months later she is almost clear. She is down to the smooth- very light- patches....we put a couple different ointments on her but also had her sit in our hot tub(the chlorine helped it) Not sure if you have access to a pool or hot tub, but you might want to try that....Also, if you continure to get strep throat, I would maybe consider having your tonsils removed.(not fun but worth it in the long run)..It was the best thing we did for our daughter!! Good luck and keep us posted.....Jami

[ERNIES]

I was diagnosed with g back in November after returning from a business trip. Outbreak was all over my body basically and a biopsy confirmed guttate. I went through several different antibiotics and doses of pred as well as a number of different topical steriods. Switched Derms since I felt like mine was indifferent, the new one recommended light therapy. I started this in December and tried to go 2-4 times a week. It was very effective in getting rid of the itching as well as the raised lesions. The frustrating part is that it would almost completely clear me but if for some reason I was not able to go in 2-4 times (like the dr's being closed a few times) then it would flair up with a vengence. I would return and it would settle down but now i've been going through this same cycle since December where it seems to be fading but then I miss a few days and it comes back. Now that warm weather is here I am soooooo embarrassed to wear short sleeve shirts. Very depressing! The nurses tell me that natural sun will help just as well as the narrowband but its difficult to gain the courage to sit outside with no shirt on looking like I have the measles.
Sorry to be discouraging but I am just at a low right now and feel like this will never go away. :-(

[RichJ]

hi ERNIES
sorry you are having a hard time but welcome to the p family. you have meet some of the wonderful people on here and will find alot of great info. welcome and nices to meet you.

try and have a good a night all

[jburgessjr]

Hello everyone...I had some type of upper respiratory infection in November of last year. I thought it was the flu, so I took medicine called Tamiflu. Shortly thereafter, I broke out in what I initially thought to be psoriasis (I've had plaque psoriasis my whole life) As the spots on my body started to develop, I began to realize that this was not at all similar to plaque p.
I did research and thought it was guttate psoriasis or an allergic reaction to the Tamiflu.
My dermitologist thought it was either, so he gave me a kenalog shot and sent me home. I had little or no results, so i went back and he put me on soriatane for about a month. Again I had no result...just a lot of itching dry flaky skin...I think it actually made my condition worse. In the meantime, My derm did a biopsy and it came back as an allergic reation, but not psoriasis. With that in mind, he told me to stop the soriatane and he gave me a double dose of Kenalog. I was starting to clear up almost completely for 2 months...Then 2 days ago I flared up again. I went to a dif. derm. and she told me what I initially suspected...Guttate psoriasis. She told me it is often difficult to read g.p. in a biopsy. She also said guttate is very difficult to get rid of. She recommended uvb treatment. I go for my first treatment on June 8th. Hope it works...It has been a rollercoaster ride...

[chaimFL]

UVB is one of the "classic" treatments that GP responds to. My advise would be to do it as aggressively as your derm and your schedule will allow.

I do UVB treatments 6 times a week and saw clearing in about 2-3 weeks. Almost totally clear after 1 month. I was treating plaque, not guttate.

[RichJ]

hi jburgessjr,
sorry i can't help much but welcome to the p family. you will met alot of wonderful people on here and fine alot of great info. welcome and nice to meet you. i hope it works for you

have a good day all

richard
__________________

[TheDG]

Hello everyone,

I just joined the site today after trying to do some research on my new found affliction. A couple weeks back I had a streptococcal infection that has since been cleared but now I am left covered from head to toe with what my doctor describes as guttate psoriasis. I originally had plaque psoriasis, which was confined to the back of my upper arms and the front of my calves, but now suddenly I am covered. It's a hard thing to have to come to grips with and I think the worst part has to be your self perception. I work part-time in the restaurant industry and watching people follow my hands as i move is a bit unnerving and the patches on my forehead don't help. Battling this type of ailment with cream seems a bit overwhelming as i can't even count the number of droplets I see when I look in the mirror. I guess it's something I'll have to come to grips with and hopefully my derm can help but man does this suck. Perhaps I'll get lucky and this outbreak will disappear as quickly as it came so here's hoping.

Glad to find such a great site with so many helpful members. I'm sure I'll be back again soon.