Psoriasis and Tonsillitis: What's the Connection?

Myth or fact: there is a connection between the onset of psoriasis and tonsillitis. Some researchers believe repeated bouts of streptococcal throat infection can lead to activation of T cells within the tonsils.

A study at the University of Michigan examines this link and how T cells can affect the development of skin lesions. Therefore the question for further investigation is: Can removing tonsils help eliminate psoriatic skin conditions?

What exactly is the connection?

Psoriasis is a chronic autoimmune inflammatory skin condition that affects between 1% and 3% of the world’s population.

There is no known cause or cure for psoriasis. This inflammation triggers the increased production of new skin cells that build up upon one another causing the development of plaques.

What are the different types of psoriasis?

There are several different types of psoriasis that can affect skin in different ways. They include:

• Plaque psoriasis (the most common form)
• Guttate psoriasis
• Inverse psoriasis
• Pustular psoriasis
• Erythrodermic psoriasis

Guttate psoriasis is the second most common type of psoriasis. It generally affects children and young adults and is often triggered by a streptococcal bacteria infection.

Certain types of infections including strep throat and tonsillitis have been associated with the onset or exacerbation of psoriasis. The strongest clinical correlation between streptococcal infection and psoriatic flare-ups are associated with guttate psoriasis.¹

Research on tonsillectomy and psoriasis symptoms

Whether tonsillectomy decreases psoriatic symptoms has been the focus of several studies around the world including Japan, Iceland and the US as well as thorough literature reviews. Some studies have indicated that tonsillectomy may be effective for the treatment for psoriasis.

Psoriasis is thought to result from a combination of genetic and environmental factors such as infection, stress, injuries, cigarette smoking, obesity and certain medications. Streptococcal infection has been shown to be a significant factor.

The literature reports that some people experience partial or complete remission of psoriasis following tonsillectomy.² Additional research is still needed before doctors can say who is most likely to benefit from the surgery, and how long the improvement will last.²

A deeper look at the role of T-cells

A study found sustained improvement after tonsillectomy ranging from 30 to 90% reduction in psoriasis severity. The clinical improvement in individual patients also realized a reduction in the frequency of autoreactive, skin-homing circulating T cells. This suggests an explanation for why a tonsillectomy is beneficial.³

Psoriasis is a T-cell mediated (immune response) disease. Literature review suggests that certain T cells targeted against streptococcal M proteins in the tonsils may cause exacerbations of psoriasis.⁴ T cells may move into the peripheral blood circulation, resulting in the development of new skin lesions.

Could a tonsillectomy serve as a possible treatment?

Tonsillectomy as a treatment for chronic plaque psoriasis and acute guttate psoriasis has been reported in several studies.⁴ Further research is needed to assess whether clinical or demographic variables might predict which people with psoriasis would respond best to having their tonsils removed.

The impact of tonsillectomy was not significantly correlated with gender, age, duration of psoriasis, or the number of tonsillitis episodes. A question to consider is whether those who have not noticed worsening of their psoriasis in association with sore throat symptoms would also improve after tonsillectomy.

Information is still needed

Clinicians and researchers still need more information to understand the pathophysiology of psoriasis and streptococcal infections in order to determine if tonsillectomy would be an effective treatment option.

Questions include whether psoriasis subtypes can predict which people are likely to benefit from a tonsillectomy. For example, does a history of psoriasis exacerbation with tonsillitis respond better to tonsillectomy than for those who do not experience tonsillitis?

After undergoing tonsillectomy some people with psoriasis experienced a clinically statistical improvement in disease status.⁵ Some experienced improvement in skin lesions soon after surgery, and it lasted for up to two years. Others did not achieve dramatic clearance of skin lesions, but were able to use milder therapies to treat their condition.^3,6

Longer-term follow-up studies are needed to evaluate if a tonsillectomy is an option for people with persistent psoriasis associated with tonsillitis.² Any recommendations for tonsillectomy should be evaluated beyond the presence of psoriasis to consider other medical conditions and associated surgical risks.³