Case Presentation
History of present illness
A12-year-old male child came to dermatology ward with chief complaints of annular plaques (round shaped red patches) with itching since 5 days all over the body and hair loss with annular plaques.
Initial Evaluation
Laboratory studies
Initial workup from the Dermatology department revealed that his Hb-12.0g/dl, RBC-4.6M/Cumm, HCT-36.4%, MCV-78.9fl, platelet-3,68,000 , ESR-05mm 1st hour (NR-0-10mm) which were found to be normal. whereas, Antistreptolysin O TITRE test revealed 320IU/ML(NR-UP TO 200IU/ML) and CRP was found to be 68 mg/dl (NR -1-10 mg/dl).
Differential Diagnosis
Confirmatory evaluation
His physical examination revealed appearance of round shaped red patches on skin all over the body, itching - positive and ASO Titre test has elevated range that is 320IU/ML which says presence of bacterial infection caused by Group A Streptococcus which commonly causes strep throat and related illness.
Discussion
Psoriasis is an inflammatory skin condition that causes discoloration and irritation, it comes in different forms. on light and fair skin tones appears as raised, red or pink patches of skin that are often paired with silvery skin. On medium skin tones it may look salmon-coloured with silvery-white scales. On darker skin tones, the patches may appear as violet or dark brown.1
Guttate psoriasis is a psoriasis that shows up on your skin as red, scaly, small teardrop-shaped spots. you usually get it as a child or young adult.2
Guttate psoriasis typically develops 1–2 weeks after a streptococcal infection of the upper respiratory tract, particularly tonsillitis, or other sites suchas perianal streptococcal dermatitis. Beta-haemolytic streptococci can directly stimulate skin-homing T-cell proliferation in the tonsils.3
It can be mild (few spots cover 3% of skin), moderate(lesions cover about 3%-10% of skin), severe(10% to entire body).2
In addition to strep throat, the following may trigger an attack
Bacteria or viral infections, including upper respiratory infections
Injury to skin, including cuts, burns, and insect bites
Stress, sunburn
Weakened immune system4
Etiology and Epidemiology
Recent upper respiratory infections or oropharyngeal or perianal streptococcal infections are risk factors for guttate psoriasis. Usually, infections start one to three weeks prior to the development of guttate lesions. Lesions associated with guttate psoriasis have also been reported after TNF-alpha therapy.
Slightly more than 2% of people worldwide suffer from psoriasis; in the US and Canada, that number might reach 4%. Psoriasis typically has a bimodal peak of onset. Ages 20 to 30 and 50 to 60 are potential peaks for the onset. Less than thirty percent of all instances of psoriasis are guttate. It affects people of both sexes equally and is more prevalent in kids and teenagers than in adults over thirty.
Pathophisiology
Streptococcal super antigens are thought to promote the skin's T cell proliferation in guttate psoriasis. It was discovered that the sequences of the human keratin 17 proteins and streptococcal M proteins are quite similar. Given that K17 and M6 peptides evoked CD8 (+) T cell IFN-γ responses in individuals carrying the main histocompatibility HLA-Cw6 allele, molecular mimicry may be involved in these cases.5
Clinical Features:3
Acute onset over days
Numerous small patches (<1 cm)
Pink, scaly, thin patches or plaques of psoriasis
Scale can be subtle in early lesions
Widespread lesions predominantly over the trunk and limbs
Lesions on the face, scalp, and ears tend to be faint and short-lived
Article DOI
