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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?

Are certain types of psoriasis more connected with strep infections?

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.

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

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

What does the literature say?

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 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 the why a tonsillectomy is beneficial.3

A deeper look at the role of T-cells

Psoriasis is a T-cell mediated (immunoresponse) 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.

Tonsillectomy as a treatment for psoriasis

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 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.

What’s the verdict?

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 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

Leavitt, M. Could removing your tonsils help psoriasis? Published December 15, 2014. Accessed online May 4, 2018. Rachakonda, TD Dhillon, JS, Effect of tonsillectomy on psoriasis: a systematic review. J Am Acad Dermatol. 2015;72(2):261-75. Published February 2015. Accessed online May 5, 2018 Thorleifsdottir RH, Sigurdardottir SL, et al. 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. Published May 15, 2012 J Immunol. 2012;188(10):5160-5. Accessed online May 5, 2018 4 Wu W, Debbaneh M, Moslehi H, Tonsillectomy as a treatment for psoriasis: a review. J Dermatolog Treat. 2014;25(6):482-6. Published November 27, 2013. Accessed online May 5, 2018 5 Bankhead, C. Psoriasis and Tonsillectomy: A Real Head Scratcher. Published March 24, 2015. Accessed online May 4, 2018 6 Miller, T. Could removing tonsils improve guttate psoriasis? National Psoriasis Foundation. Published May 6, 2015. Accessed online May 4, 2018


  • karisivley
    3 months ago

    My name is Kari and I am 23 years old and now working as a registered nurse! I wanted to share my psoriasis story to hopefully help others and research one day. When I was 16 and very active playing a multiple sports in high school I ended up getting my first strep infection since I had been very very young. I was prescribed antibiotics and quickly the strep throat infection and miseries that come with it got better but I started to develop these small flaky plaque like spots on my chest and thighs. My mom thought I was having a minor reaction to antibiotics and went back to the doctor and was given steroids intended to fight an allergic reaction. Within two days my almost entire body and scalp were covered with those plaque like red spots with the exception of my face. It was literally the worst of the worst photos you could find if you googled pictures of “severe guttate psoriasis”. It took a minute for us to finally get in with a dermatologist. They took a biopsy and confirmed it was psoriasis specifically guttate. Lord knows what my family paid for this Vaseline like gooey ointment I had to slather on me which would stain and ruin clothes sheets etc and the glorified fortune we spent with “light therapy” which was literally a tanning bed. We couldn’t afford light therapy so I starting to go to tanning beds which did have a significant impact and reduction but still had over 70% of my body covered in psoriasis. At this point it had been 6 months and had tested positive for strep twice more. At this time my mom and doctor decided I needed my tonsils removed. Within one week of having my tonsils removed the psoriasis on my body had cleared by 50%. In 6 weeks there was not a single spot of psoriasis on my body. 7-8 years later I have never had one singular break outs. At that time I couldn’t hardly find any literature related to tonsil removal and psoriasis remission I had only heard upper respiratory and strep could exacerbate it. I still don’t understand it neither did my PCP and I pray I never have an outbreak like that again. I see that research is immerging in relation to a possible connection between tonsil removal and improvement with psoriasis. I truly hope my case may add to or help some kind of further research and answers in relation to psoriasis considering causes and cures to this day are not definite. Good luck to everyone and you are all beautiful!

  • mare8
    9 months ago

    I developed the expression of plaque psoriasis shortly after removal of tonsils and adenoids at the age of 8 years old. I think that this line of thinking, that tonsillectomy is a treatment for psoriasis, is backwards, at least where children are concerned. The tonsils and adenoids are very important for normal immune system development, especially in children when the immune system is sensitive. As research is now revealing, early tonsillectomy and appendectomy are a set up for increased upper respiratory tract infections going forward. I remained very susceptible to strep throat throughout my young adult life. It will be interesting to see how research in the future unfolds.
    On another note, I have had almost complete resolution of psoriasis (except for occasional stress triggered outbreaks on the scalp) by elimination of wheat and all other grains from my diet, as well as supplements that include, vitamins A,B complex,C, D, E, flax-seed, fish oil, lecithin, and zinc .

  • CathyD moderator
    9 months ago

    That’s really interesting, @mare8. Thank you for taking the time to share your experience. It’s fascinating how the adenoids and tonsils work to protect the body from infection. I’m sorry to read that your psoriasis appeared not long after the surgery. I wonder if another aspect was the stress on your body from the surgery? I have heard a few people say that they flared following different types of surgery. It’s definitely a very interesting topic; I’m curious to see what future research shows too!

    Thanks so much for sharing about your dietary changes and the supplements you are taking – it is wonderful to read that your psoriasis is doing well with them!

    -Catherine, Community Moderator

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