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Journal of the American Academy of Dermatology
Volume 72, n° 2
pages 261-275 (février 2015)
Doi : 10.1016/j.jaad.2014.10.013
accepted : 10 October 2014
Original Articles

Effect of tonsillectomy on psoriasis: A systematic review
 

Tara D. Rachakonda, MD, MSCI a, Jaskaran S. Dhillon b, Aleksandra G. Florek, MD c, April W. Armstrong, MD, MPH c,
a Department of Internal Medicine, University of Utah, Salt Lake City, Utah 
b Department of Dermatology, University of California at Davis School of Medicine, Sacramento, California 
c Department of Dermatology, University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colorado 

Reprint requests: April W. Armstrong, MD, MPH, Department of Dermatology, University of Colorado at Denver, Anschutz Medical Campus, 12801 E 17 Ave, Campus Mailbox 8127, Aurora, CO 80045.
Abstract
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.

The full text of this article is available in PDF format.

Key words : outcomes research, psoriasis, streptococcal infection, systematic review, tonsillectomy, tonsillitis



 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.



© 2014  American Academy of Dermatology, Inc.@@#104156@@