Improvement of Refractory Psoriasis vulgaris after Tonsillectomy

Abstract

In order to ascertain what effect tonsillectomy may have in the treatment of children and adolescents with recurring psoriasis vulgaris, refractory to topical therapy and courses of penicillin, and triggered by infection, and also to test a possible correlation between tonsillitis and exacerbations of psoriasis, a retrospective study of the course of psoriasis after tonsillectomy, using charts and questionnaires, was undertaken in 74 psoriatic patients. Each patient served as his own control. The average age of the patients at tonsillectomy and the duration of psoriasis were 14.2 years and 4.5 years, respectively, while the average follow-up period was 4.5 years. The clearing of the psoriasis was statistically significant (p < 0.01) as it occurred throughout the entire follow-up period in one-third of the patients, while an additional third noticed considerable improvement of their psoriasis. After trying topical therapies of various sorts as well as courses of penicillin, tonsillectomy might be considered for recurring, refractory psoriasis vulgaris in children and adolescents.

Identical TCR β-Chain Rearrangements in Streptococcal Angina and Skin Lesions of Patients with Psoriasis Vulgaris

“…In all three patients, tonsillectomy was followed by a long-term remission of psoriasis with a complete clearance of skin symptoms now exceeding 3 years. This obvious correlation between removal of the tonsils and recovery from psoriasis supported that the streptococcal angina had acted as a trigger for psoriasis in these patients, and it confirmed former observations that tonsillectomy may improve the course of streptococcal-driven psoriasis (27)(28)(29).…”

“…Despite a history of permanently active, recalcitrant psoriasis of 1.5, 6, or 10 years, tonsillectomy was followed by a long-term remission of psoriatic skin inflammation Ͼ3 years in all three patients. A similar beneficial role of tonsillectomy on the course of psoriasis has been documented in several case reports and retrospective or prospective clinical trials (27)(28)(29). Furthermore, a patient with poststreptococcal arthritis who improved after tonsillectomy had identical TCR rearrangements in tonsils and inflamed joints (43).…”

Bedeutung von Streptokokken für die Psoriasispathogenese

“…1 9 Chronische Tonsillenhypertrophie bei Psoriasis mit rezidivierenden Streptokokkeninfektionen riasis und ihre Rezidive in direktem Zusammenhang mit einer akuten Streptokokkenangina oder einer chronischen Streptokokkenträgerschaft standen. Etwa zwei Drittel der Patienten erfuhren hierbei eine weitgehende Abheilung oder deutliche Besserung der Psoriasis mit länger-fristigen oder dauerhaften Remissionen in einem Beobachtungszeitraum von bis zu 5 Jahren [8,20,27,32,48]. Psoriasisrezidive nach Tonsillektomie werden einer erneuten Hyperplasie des Restgewebes, die als Folge einer inkompletten Tonsillektomie möglich ist, und einer Streptokokken-Kolonisierung anderer lymphatischer Gewebe im oberen Respirationstrakt zugeschrieben [35,46].…”

Improvement of Psoriasis after Tonsillectomy Is Associated with a Decrease in the Frequency of Circulating T Cells That Recognize Streptococcal Determinants and Homologous Skin Determinants

“…There are several reports of partial or complete remission of psoriasis following tonsillectomy (20,21), including three patients who were shown to have identical T cell clones in their palatine tonsils and skin lesions (20). However, to our knowledge, no controlled prospective trial has been reported.…”