Psoriasis is a chronic autoimmune (T cell-mediated) skin disease with fluctuating evolution. There is a strong genetic component, but environmental factors also play a role.
Strepococcal infection, especially streptococcal tonsillitis, has been shown to be an important and significant trigger of psoriasis particularly for children ant probably for teenagers.
It as been proposed that certain T cells sensitized against streptococcal proteins into the tonsils may cross-react with epitopes from keratinocytes to provoque exacerbations of psoriasis (specialy guttate psoriasis, palmoplantar psoriasis and pustular psoriasis).
The use of antibiotics and/or tonsillectomy to treat psoriasis remains controversial.
We evaluated the impact of tonsillectomy in 52 cases psoriasis guttata patients (children and teenagers) for 10 years.
Overall, more than 80 % had an significant improvement or decrease of their psoriasis (between 10 to 30 days after tonsillectomy).
The rate of recurrence was aproximatively 20 % (2 to 9 year follow-up period).
Some patients have been lost to follow-up (10 %).
In our study, we have no patients experiencencing disease worsening after the opération.
Tonsillectomy appears useful for children psoriasis with evidence of subclinical or recurrent streptococccal infection who fail to respond to more conservative therapies and one or several courses of antibiotics.
The privileged collaboration with an informed and competent E.N.T. is primordial.
Further research (additional data, case reports and series) is still needed in evaluating the prévalence and efficacy of tonsillectomy in the treatment of psoriasis.
Prof. D.TENNSTEDT, Dr. B. LEROY (dermatologists UCL Brussels)
Dr X. STORME (E.N.T. Clinic Gosselies and private practice)