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In some people, guttate psoriasis may reappear with successive attacks of tonsillitis. In those cases physicians often recommend removal of the tonsils to avoid recurrences of the psoriasis. Similarly, successive streptococcal infections in older individuals can lead to a recurrence. Penicillin has been used as a preventative therapy to avoid occurrence of an infection that will cause an outbreak.
Guttate flare-ups in children tend to continue throughout the teenage years and into early adulthood, but decrease with age. However, the form can evolve into a chronic form of psoriasis. One study has estimated that 14% to 17% of chronic psoriasis cases were initiated by guttate outbreaks.
It has been observed that in persons with psoriasis of the chronic plaque type, an acute guttate flare-up can develop following application to the skin of steroids under occlusive dressings (i.e. plastic film, saran wrap, etc.).