Infection:Streptococcal infection is strongly associated with the development of guttate psoriasis but this may also apply to chronic plaque psoriasis. Chronic plaque psoriasis is typified by itchy, well-demarcated circular-to-oval bright red/pink elevated lesions (plaques) with overlying white or silvery scale, distributed symmetrically over extensor body surfaces and the scalp. There is no strong evidence that any of the interventions have a disease-modifying effect or impact beyond improvement of the psoriasis itself. A Cochrane review found that potent to very potent corticosteroids perform as well as vitamin D analogues, with a lower incidence of local adverse events but combining corticosteroid with vitamin D analogue was the most effective. Highlighted Cochrane Review. Topical treatments for chronic plaque psoriasis. Antistreptococcal interventions for guttate and chronic plaque psoriasis. The choice of treatment for guttate psoriasis is hampered by the lack of controlled trials for the available therapies, as Drs Caroline Owen and Robert Chalmers report.
Acute guttate psoriasis is a common presentation of psoriasis in children and adolescents. May completely remit within a few months or chronic plaques may follow. Cochrane review: Antistreptococcal interventions for guttate and chronic plaque psoriasis. Patients with guttate psoriasis typically present with the acute onset of numerous small, inflammatory, scaly plaques on the trunk and extremities (picture 1A-B). 8 percent of the general population 1, with chronic plaque psoriasis as the most common clinical presentation. Cochrane Database Syst Rev 2000;:CD001213. A systematic review of antistreptococcal interventions for guttate and chronic plaque psoriasis. Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database Syst Rev. Psoriasis: a review of diagnosis and management.