Effect of tonsillectomy on psoriasis: A systematic review

Rachakonda, Tara; Dhillon, Jaskaran S.; Florek, Aleksandra G.; Armstrong, April W.

doi:10.1016/j.jaad.2014.10.013

Cited by 66 publications

(58 citation statements)

References 40 publications

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“…), driving the cutaneous inflammation characteristic of psoriasis. Several studies have indicated that psoriasis can improve after tonsillectomy (31) (and Sigurdardottir SL, Br J Dermatol. 2013 Feb;168(2):237–42), but indications for such treatment remain to be established.…”

Section: Discussionmentioning

confidence: 99%

Throat Infections are Associated with Exacerbation in a Substantial Proportion of Patients with Chronic Plaque Psoriasis

et al. 2014

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Streptococcal throat infections are known to trigger or exacerbate psoriasis, and several studies support the benefit of tonsillectomy. To evaluate the potential of tonsillectomy as a treatment, we used a retrospective study-specific questionnaire to assess the proportion of psoriasis patients with sore throat-associated psoriasis exacerbations. Our survey sampled 275 psoriasis patients. 42% of patients with plaque psoriasis reported sore throat-associated psoriasis exacerbations, and 72% of patients with confirmed streptococcal infections reported aggravation. Notably, women and early onset psoriasis patients were more likely to report psoriasis exacerbation after a sore throat (p<0.001, p=0.046 respectively). Other psoriasis aggravation factors were more common in patients with sore throat-associated exacerbations (p<0.01). 49% of tonsillectomized patients reported subsequent improvement and had more frequent sore throat-associated aggravation of psoriasis than patients who did not improve after tonsillectomy (p=0.015). These findings suggest a closer association between sore throats, streptococcal throat infections and plaque psoriasis than previously reported.

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Section: Discussionmentioning

confidence: 99%

Throat Infections are Associated with Exacerbation in a Substantial Proportion of Patients with Chronic Plaque Psoriasis

et al. 2014

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“…5-7 It has been proposed that T cells, primed by streptococcal antigens in the palatine tonsils, may migrate to the skin where they may react to antigens that share sequence homology with streptococcal proteins. 8-10 A number of studies have shown partial or complete remission of psoriasis after tonsillectomy, 11-13 and we have recently conducted a prospective, randomized, and controlled study indicating that tonsillectomy can lead to a marked clinical improvement of chronic plaque psoriasis. 14 …”

Section: Introductionmentioning

confidence: 99%

HLA-Cw6 homozygosity in plaque psoriasis is associated with streptococcal throat infections and pronounced improvement after tonsillectomy: A prospective case series

Thorleifsdottir

Sigurðardóttir

Sigurgeirsson

et al. 2016

Journal of the American Academy of Dermatology

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Background Carriage of the HLA-Cw*0602 allele is associated with a particular set of clinical features and treatment responses in psoriasis. Tonsillectomy can improve psoriasis. Objectives To evaluate whether HLA-Cw*0602 predicts a favourable outcome after tonsillectomy of psoriasis patients. Methods This prospective case series followed 28 tonsillectomized patients with plaque psoriasis for 24 months. The Psoriasis Area and Severity Index (PASI), the Psoriasis Disability Index (PDI) and the Psoriasis Life Stress Inventory (PLSI) were used for assessment. Tonsils were swabbed for bacteria and patients genotyped for HLA-Cw*0602. Results After tonsillectomy, HLA-Cw*0602 homozygotes showed significantly more improvement, compared with heterozygous and HLA-Cw*0602 negative patients. Thus, PASI was reduced by 82% in the homozygous patients compared with 42% and 31% respectively (P < .001), PDI improved by 87% compared with 38% and 41% respectively (P < .001) and PLSI was 82% reduced compared with 60% and 54% respectively (P < .001). The homozygotes had more often psoriasis onset associated with a throat infection (P = .007) and an increased frequency of streptococcal throat infections per lifetime (P = .038). Limitations Few patients were included and some data was retrospective. Conclusions Homozygous HLA-Cw*0602 carriage in plaque psoriasis may predict a favourable outcome after tonsillectomy.

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“…This systematic narrative literature review [213] included all controlled trials or observational studies in which patients with psoriasis vulgaris (author’s note: not psoriasis guttata) had undergone TE and were examined at least once after surgery. From 674 hits, 20 studies were eligible for further analysis, including one RCT [214], one retrospective study [208], 4 prospective observational studies [215], [216], [217], [218], 7 case reports [200], [211], [219], [220], [221], [222], [223] (<5 patients per study), and 7 case series [209], [210], [224], [225], [226], [227], [228] (≥5 patients per study).…”

Section: Resultsmentioning

confidence: 99%

Indications for tonsillectomy stratified by the level of evidence

Windfuhr

2016

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 15:Doc09

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Effect of tonsillectomy on psoriasis: A systematic review

Cited by 66 publications

References 40 publications

Throat Infections are Associated with Exacerbation in a Substantial Proportion of Patients with Chronic Plaque Psoriasis

Throat Infections are Associated with Exacerbation in a Substantial Proportion of Patients with Chronic Plaque Psoriasis

HLA-Cw6 homozygosity in plaque psoriasis is associated with streptococcal throat infections and pronounced improvement after tonsillectomy: A prospective case series

Indications for tonsillectomy stratified by the level of evidence

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