Treatment of psoriasis traditionally has been directed at epidermal symptoms. Recent findings from a prospective study have implicated a circulating cross-reactive T-cell population in psoriasis etiology. These T cells appear to originate from streptococcal infection in the tonsils, and the study showed that tonsillectomy may lead to stable clinical improvement in psoriasis. Here, we review previous case reports and retrospective studies of tonsillectomy in the treatment of psoriasis and discuss findings in relation to the prospective study.
GudjonssonJ.E., ThorarinssonA.M., SigurgeirssonB., KristinssonK.G., ValdimarssonH.Streptococcal throat infections and exacerbation of chronic plaque psoriasis: a prospective study. Br J Dermatol.2003; 149(3): 530–534.
2.
PrinzJ.C.Psoriasis vulgaris — a sterile antibacterial skin reaction mediated by cross-reactive T cells? An immunological view of the pathophysiology of psoriasis. Clin Exp Dermatol.2001; 26(4): 326–332.
3.
SwerlickR.A., CunninghamM.W., HallN.K.Monoclonal antibodies cross-reactive with group A streptococci and normal and psoriatic human skin. J Invest Dermatol.1986; 87(3): 367–371.
4.
ShikhmanA.R., CunninghamM.W.Immunological mimicry between N-acetyl-beta-D-glucosamine and cytokeratin peptides. Evidence for a microbially driven anti-keratin antibody response. J Immunol.1994; 152(9): 4375–4387.
5.
SigurdardottirS.L., ThorleifsdottirR.H., ValdimarssonH., JohnstonA.The role of the palatine tonsils in the pathogenesis and treatment of psoriasis. Br J Dermatol.2013; 168(2): 237–242.
6.
HarabuchiY.Clinical manifestations and pathogenesis of tonsillar focal diseases: IgA nephropathy and palmoplantar pustulosis. Adv Otorhinolaryngol.2011; 72: 1–5.
7.
WilsonJ.K., Al-SuwaidanS.N., KrowchukD., FeldmanS.R.Treatment of psoriasis in children: is there a role for antibiotic therapy and tonsillectomy?Pediatr Dermatol.2003; 20(1): 11–15.
8.
OwenC.M., ChalmersR.J., O'SullivanT., GriffithsC.E.A systematic review of antistreptococcal interventions for guttate and chronic plaque psoriasis. Br J Dermatol.2001; 145(6): 886–890.
9.
NodaY.Pre-operative diagnosis for dermatoses due to tonsillar focal infections: recent views. Auris Nasus Larynx.1989; 16 Suppl 1: S59–64.
10.
WuW., DebbanehM., MoslehiH., KooJ., LiaoW.Tonsillectomy as a treatment for psoriasis: A review. J Dermatolog Treat.2014; 25(6): 482–486.
SaitaB., IshiiY., OgataK., KikuchiI., InoueS., NaritomiK.Two sisters with guttate psoriasis responsive to tonsillectomy: case reports with HLA studies. J Dermatol.1979; 6(3): 185–189.
13.
HoneS.W., DonnellyM.J., PowellF., BlayneyA.W.Clearance of recalcitrant psoriasis after tonsillectomy. Clin Otolaryngol Allied Sci.1996; 21(6): 546–547.
14.
McMillinB.D., MaddernB.R., GrahamW.R.A role for tonsillectomy in the treatment of psoriasis?Ear Nose Throat J.1999; 78(3): 155–158.
15.
YokoyamaM., HashigucciK., YamasakiY.Effect of tonsillectomy in patients with pustulosis palmaris et plantaris. Acta Otolaryngol.2004; 124: 1109–10.
16.
TakaharaM., KishibeK., NozawaH., HarabuchiY.Increase of activated T-cells and up-regulation of Smad7 without elevation of TGF-beta expression in tonsils from patients with pustulosis palmaris et plantaris. Clin Immunol.2005; 115(2): 192–199.
17.
TakaharaM.Clinical outcome of tonsillectomy for palmoplantar pustulosis and etiological relationship between palmoplantar pustulosis and tonsils. Adv Otorhinolaryngol.2011; 72: 86–88.
18.
NyforsA., RasmussenP.A., LemholtK., EriksenB.Improvement of recalcitrant psoriasis vulgaris after tonsillectomy. J Laryngol Otol.1976; 90(8): 789–794.
19.
ThorleifsdottirR.H., SigurdardottirS.L., SigurgeirssonB.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. J Immunol.2012; 188(10): 5160–5165.
