Psoriasis and Tonsillectomy: Budding Relationhip?

Skin disease often improves after surgery, but no one usually knows why.

Patients with plaque psoriasis often experience clear improvement in their skin conditions after undergoing tonsillectomy.

A retrospective study of 410 specific cases was conducted to evaluate evidence that could support tonsillectomy as a potential treatment option for patients with plaque psoriasis associated with episodes of tonsillitis.

The study results indicated that psoriasis improved in 290 of the patients during the brief follow-up period post-surgery. While some saw improvement in psoriasis symptoms immediately after surgery, others experienced prolonged disease-free periods of 2 to 10 months. Furthermore, some patients' psoriasis became more responsive to treatment during flares as opposed to treatment prior to the surgery.

However, limited information regarding patient populations prevented an accurate determination of the extent of benefits from tonsillectomy for psoriasis patients, Aleksandra G. Florek, MD, of the University of Colorado in Denver, and colleagues concluded in a presentation at the American Academy of Dermatology meeting.

Abby VanVoorhees, MD, of the University of Pennsylvania in Philadelphia, and a spokesperson for the National Psoriasis Foundation, commented, “The question of whether tonsillectomy might be helpful to improve the status of psoriasis has long been questioned. Unfortunately the literature is quite weak, leaving the question still mostly unanswered in my opinion. If you look at the poster, most of the cases are single case reports, and while interesting, not conclusive.”

Streptococcal infection has been hypothesized as one potential mechanism for psoriasis etiology and pathogenesis. Conceivably, a streptococcal trigger in the tonsils might activate “skin-homing” T cells to initiate psoriasis.

Florek and colleagues concluded that controlled studies and long-term follow-up are necessary to effectively determine the symbiotic relationship between tonsillectomy and plaque psoriasis.

So, naturally, until further information is released, the surgical procedure should only be considered a last minute option — not a routine plaque psoriasis treatment method.

“In certain cases, tonsillectomy may be reserved for selected patients with recalcitrant and recurrent psoriasis exacerbations associated with chronic tonsillitis,” said the authors.

Additionally, as with many specialties, it’s crucial for physicians to communicate with patients considering tonsillectomy about potential adverse events associated with the procedure, such as infection, hemorrhage, laryngospasm, bronchospasm, temporomandibular joint dysfunction, and vocal changes.

“Based on this comprehensive systematic review on the effect of tonsillectomy on psoriasis, we found that although tonsillectomy is effective in ameliorating psoriasis in a subpopulation of patients, there are insufficient data to describe the differences in clinical characteristics between responders versus non-responders to tonsillectomy,” the authors concluded.