REVIEW · November 20, 2014
TAKE-HOME MESSAGE
The authors of this systematic review of 20 studies with 545 patients evaluated the relationship between tonsillectomy and psoriasis. Approximately 70% of patients with psoriasis who underwent tonsillectomy experienced improvement in psoriasis. While some patients had sustained improvements, others later relapsed.
There is insufficient evidence to recommend tonsillectomy as a standard treatment for patients with psoriasis, but it may be helpful for specific patients who have recurrent psoriasis exacerbations associated with recurrent tonsillitis.
– Sarah Churton, MD
ABSTRACT
BACKGROUND
Streptococcal infection is associated with psoriasis onset in some patients. Whether tonsillectomy decreases psoriasis symptoms requires a systematic review of the literature.
OBJECTIVE
We sought to determine whether tonsillectomy reduces psoriasis severity through a comprehensive search of over 50 years of literature.
METHODS
We searched MEDLINE, CINAHL, Cochrane, EMBASE, Web of Science, and OVID databases (from August 1, 1960, to September 12, 2013) and performed a manual search of selected references. We identified observational studies and clinical trials examining psoriasis after tonsillectomy.
RESULTS
We included data from 20 articles from the last 53 years with 545 patients with psoriasis who were evaluated for or underwent tonsillectomy. Of 410 reported cases of patients with psoriasis who underwent tonsillectomy, 290 experienced improvement in their psoriasis. Although some patients who underwent tonsillectomy experienced sustained improvement in psoriasis, others experienced psoriasis relapse after the procedure.
LIMITATIONS
Fifteen of 20 publications were case reports or series that lacked control groups. Publication bias favoring reporting improved cases needs to be considered.
CONCLUSION
Tonsillectomy may be a potential option for patients with recalcitrant psoriasis associated with episodes of tonsillitis. Studies with long-term follow-up are warranted to determine more clearly the extent and persistence of benefit of tonsillectomy in psoriasis.
Journal of the American Academy of Dermatology
Effect of Tonsillectomy on Psoriasis: A Systematic Review
J Am Acad Dermatol 2014 Nov 20;[EPub Ahead of Print], TD Rachakonda, JS Dhillon, AG Florek, AW Armstrong