Biologics and Small Molecules in Guttate Psoriasis-Nonsense or New Sense? A Narrative Review

Guttate psoriasis (GP) is a clinical variant of psoriasis defined by morphology, triggers, and course. It is more common among children, adolescents, and young adults. Up to 70% of patients follow a chronic course, some with a switch to plaque psoriasis. Classic treatment for GP consists of topical corticosteroids, anthralin and vitamin-D analogues alone or in combination with ultraviolet B phototherapy. Small molecules and biologics have revolutionized the treatment of moderate to severe chronic plaque psoriasis. In this narrative review their potential in GP therapy is discussed and first clinical data are presented. Inhibition of the interleukin (IL)-23 pathway offers rapid clearance and durable remissions. Further trials are necessary. Possibly, the chronic course and switch to plaque psoriasis may be prevented by early use of IL-23 antagonists.