Two Sisters With Guttate Psoriasis Responsive to Tonsillectomy

Abstract

An 11‐year‐old girl and her 7‐year‐old sister, both with guttate psoriasis, both showed chronic tonsillitis and proteinuria. The ASO titer of the elder sister was 480 units and that of the younger sister 320 units. Tonsillectomies were performed on both sisters because they developed guttate psoriasis after colds with severe sore throats and proteinuria. Skin lesions improved markedly and proteinuria disappeared, but ASO titers did not change significantly. HLA studies were made of the sisters and their parents; A1 and B37 were confirmed in both sisters and their mother.

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].…”

Indications for tonsillectomy stratified by the level of evidence

“…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). 12 articles were published before 1980, 8 since 1994.…”

Tonsillectomy as a treatment for psoriasis: A review

“…A study of two Japanese sisters ages 7 and 11 with guttate psoriasis reported 100% clearance of the psoriasis within two and six months after tonsillectomy, respectively. Of note, the two sisters also had a history of proteinuria that was also cleared after tonsillectomy (22). …”