Original article
Effect of tonsillectomy on psoriasis: A systematic review

https://doi.org/10.1016/j.jaad.2014.10.013Get rights and content

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.

Section snippets

Data search

We searched MEDLINE, CINAHL, Cochrane, EMBASE, Web of Science, and OVID databases for articles published from August 1, 1960, to September 12, 2013. For MEDLINE, the following Medical Subject Headings (MeSH) were combined using the AND command:

  • Psoriasis [MeSH].

  • Tonsillectomy [MeSH Major Topic] OR Tonsillitis [MeSH Major Topic].

We also combined the aforementioned terms in an identical manner to locate pertinent citations in the other electronic databases: EMBASE, CINAHL, OVID, Web of Science, and

Results

Based on the aforementioned inclusion and exclusion criteria, we identified 674 initial citations from the electronic search published over the past 53 years. After removal of duplicates, 249 citations were selected for additional assessment. Fig 1 is a flow diagram displaying the search process. Specifically, MEDLINE search yielded 57 unique citations, whereas the EMBASE and CINAHL searches resulted in 239 and 139 citations, respectively. The OVID search results generated 191 results. The

Discussion

This systematic review examines data from 545 patients from 8 countries in 20 studies. To our knowledge, this represents the most comprehensive systematic review on the effect of tonsillectomy on the clinical course of guttate and plaque psoriasis available to date.

The epidemiologic association between streptococcal infection and psoriasis has been noted for many decades, beginning in 1916 with the case report of Winfield42 on the emergence of psoriasis after acute tonsillitis. Since then,

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    Funding sources: None.

    Disclosure: Dr Rachakonda has served as a subinvestigator for Amgen, Abbvie, and Lilly. Dr Armstrong serves as investigator and/or consultant to Abbvie, Amgen, Janssen, Lilly, Pfizer, Celgene, Novartis, UCB, Modernizing Medicine, and Merck. Dr Florek serves as a subinvestigator for Abbvie, Lilly, Janssen, Regeneron, and Novartis. Mr Dhillon has no conflicts of interest to declare.

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