Guttate psoriasis secondary to COVID-19: A BMJ case report
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Guttate psoriasis is known to occur after acute infection. It is associated with genetic and environmental factors, and usually arises in children or younger adults. It is classically associated with streptococcal infection, although respiratory virus infection can also trigger psoriatic flares in the absence of concurrent streptococcal infection.

A 38-year-old man presented with symptoms of fever and dry cough. There was a past medical history of chronic plaque psoriasis with a single active psoriatic plaque affecting the lateral aspect of the right ankle. The patient was using no regular medication and no topical therapy for psoriasis at the time of presentation with respiratory symptoms. There were no throat symptoms and pharyngeal examination was normal. Severe acute respiratory syndrome SARS-CoV2 RNA was detected from a nasopharyngeal swab confirming COVID-19 infection.

At day 6 following the onset of fever, multiple erythematous lesions began to form inferior to the knee on the anterior and lateral aspect of the right lower limb. At day 22 the patient sought a dermatological opinion as these lesions had failed to improve.

On examination there were multiple drop-like well circumscribed salmon pink erythematous papules with a fine scale, measuring between 4 and 12?mm in size, consistent with guttate psoriasis. Blood tests showed IgG positivity for SARS-CoV2, with otherwise normal full blood count, CRP and routine biochemistry. Antistreptolysin O titre was negative at less than 200 IU/mL.

Treatment was commenced with topical readily diluted betamethasone 0.025% cream applied two times per day. There was significant clinical improvement on review after 2?weeks, with no new lesions and regression of those previously identified.