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Could removing tonsils improve guttate psoriasis?

Getting Psoriasis By the Throat

By Tamara Miller

It's a well-established phenomenon that a wicked case of strep throat often triggers a lifelong battle with psoriasis.

Until recently, researchers didn't exactly understand the connection between the streptococci bacteria and guttate psoriasis. However, recent studies show that the answer to that question may lie in the back of the throat.

It turns out that people with psoriasis and frequent sore throats often have a strep infection that antibiotics can't treat. That's because strep bacteria can hide deep in the tonsil cells in the back of the throat and antibiotics tend to only treat the external skin cells of the tonsils, said Dr. Andrew Johnston of the University of Michigan.

Johnston co-authored a study that looked at what would happen if the tonsils were removed in people who often experience strep throat and guttate psoriasis or a worsening of their plaque psoriasis. The study divided 40 people in half; half stayed on their regular psoriasis therapy while the other half also got a tonsillectomy.

The result? About a 50 percent decrease in psoriasis in those who had their tonsils removed. And those who didn't clear dramatically were able to treat their psoriasis with milder therapies.

That study was published in April 2012 in The Journal of Immunology.

In a separate paper, published online in June in Clinical & Experimental Immunology, Johnston and his team confirmed that people with psoriasis are more likely to have strep infections in their tonsils – about 40 percent compared with only 18 percent of people without psoriasis – and that their tonsils have a much larger number of skin-homing T cells. Or in other words, their tonsils carry more of the white blood cells that affect the skin.


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