MIAMI BEACH – If all else fails in treating psoriasis, a tonsillectomy may do the trick – at least in patients whose psoriasis is associated with recurrent tonsillitis, according to findings from a systematic review of available data.
“Maybe taking the tonsils out removes resident bacteria like strep whose antigens tend to promote psoriasis,” Dr. Theodore Rosen, professor of dermatology at Baylor College of Medicine, Houston, suggested during a presentation at the South Beach Symposium.
The relationship between streptococcal pharyngitis and guttate psoriasis is well known, he explained during the talk on the latest findings in clinical dermatology.
Indeed, the authors of the systematic review noted that streptococcal infection is associated with psoriasis onset in some patients, but said it was unknown whether tonsillectomy decreases psoriasis symptoms in those patients.
Dr. Tara D. Rachakonda of Salt Lake City and her colleagues included studies dating back to 1960, and identified 20 relevant studies – including 5 controlled studies – involving 545 patients with psoriasis who were evaluated for or underwent tonsillectomy. The overall improvement rate across the studies was about 70% in 410 patients who underwent tonsillectomy, and in one of the studies the response rate was 86%.
In some cases, the response was sustained, but some patients experienced relapse, they reported (JAAD 2015;72:261-75).
The authors concluded that tonsillectomy may be a potential treatment option in patients with recalcitrant psoriasis associated with episodes of tonsillitis, but noted that additional study with long-term follow-up is needed to examine both the extent and persistence of benefit of tonsillectomy in psoriasis patients.
“The evidence is not sufficient to recommend tonsillectomy in all of your psoriasis patients,” Dr. Rosen said, but he noted that it may be something worth considering in patients who still have their tonsils and who are not responding to psoriasis treatments.
Dr. Rosen reported having no relevant financial disclosures.