Clinical course of guttate psoriasis generally good
MedWire News: Study results indicate that guttate psoriasis tends to have a better prognosis than other types of psoriasis, but researchers warn that progression of the guttate form of psoriasis into the chronic plaque form is not uncommon.
Moon-Bum Kim, from Pusan National University in Busan, Korea, and colleagues followed the clinical course of guttate psoriasis in 26 patients and found that 22 (61.1%) experienced complete involution of their psoriasis with long remission of at least 1 year, whereas the remaining 14 (38.9%) patients showed incomplete involution and progressed into chronic psoriasis within an average of 6 years.
Although clinical differences were found between the two groups, none reached statistical significance.
The researchers report in The Journal of Dermatology that most of the skin lesions in the patients who experienced complete involution of their condition disappeared within 8 months.
Among the patients whose psoriasis progressed, 12 received regular treatments, while two did not. The team notes, that the participants who received regular treatments continued to suffer from the guttate form of psoriasis and had less extensive lesions than the first attack. In contrast, those not receiving regular treatments progressed to plaque-type psoriasis, suggesting that “regular treatment could be an important factor in clinical course,” the researchers point out.
Infection also appeared to have an effect on the course of guttate psoriasis, 20 (55.6%) of the patients overall had a history of previous upper respiratory infection and 23 (63.9%) showed increased anti-streptolysin O (ASO) titers. The frequency of both of these factors was higher in patients with complete involution of their psoriasis, at 63.6% and 72.7% versus 42.9% and 50.0%, respectively, in patients whose psoriasis progressed.
“Even though these results can suggest that streptococcal infection is more strongly associated with the development of guttate psoriasis in patients with good clinical course than those with a poor one, there was no significant difference between both groups,” Kim et al note.
Family history of psoriasis tended to be associated with a poor prognosis, although only four (11.1%) of the patients had a family history of psoriasis. Psoriasis in three of these patients developed into chronic psoriasis.
Similar to previous reports, the trunk and extremities were the sites most commonly involved and pruritus and itching were more common in patients with a good prognosis, although not significantly so.
The team concludes: “We could not find statistically significant differences in clinical or laboratory data between the two groups with a distinguishable clinical course.” They recommend a larger study to confirm their preliminary findings.
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By Lucy Piper