Could removing your tonsils help psoriasis? 

| Melissa Leavitt

Wouldn’t it be nice if a tonsillectomy was a psoriasis-ectomy, too? 

Getting a streptococcal infection in your throat—known as strep throat—can sometimes trigger a psoriasis flare, or even lead to new onset of the disease. In some of these cases, removing the tonsils can be a one-two punch, knocking out the throat infection and psoriasis.

But it may not be time to sign up for a tonsillectomy just yet. A new review of available data found that, although many psoriasis patients who had their tonsils removed did improve, more research is still needed before doctors can say for sure who can benefit most from the procedure, and how long the improvement will last.

The psoriasis-tonsillitis connection starts with immune cells, known as T cells, which can move from the tonsils into the skin.

“The prevailing theory is that repeated bouts of streptococcal throat infection can lead to activation of T cells within the tonsils,” said Dr. Andrew Johnston, a researcher at the University of Michigan who studies the link between psoriasis and streptococcal infection. “These T cells can enter the circulation and home to the skin, where they can initiate skin lesions.”

Removing the tonsils can get rid of the bacteria lurking in the throat, which can improve psoriasis, he explained.

According to the review, in many cases, the procedure seemed to work.

Published last month in the Journal of the American Academy of Dermatology, the review examined studies of tonsillectomy as a treatment for psoriasis published between 1960 and 2013. Together, these studies included 410 reported cases of patients with psoriasis who had their tonsils removed. Among these, 290 experienced improvement in their psoriasis following the procedure, according to the review.

But of the 20 studies included in the review, only one was a randomized controlled trial, considered the gold standard in scientific research. The rest included case reports and retrospective and observational studies.

The randomized controlled study involved 29 psoriasis patients, 15 of whom underwent tonsillectomy. Of these 15, researchers reported, 13 saw their psoriasis improve anywhere from 30 to 90 percent.

More studies like this are needed to help doctors better understand the impact of tonsillectomy as a treatment for psoriasis, the researchers noted.

Johnston agreed.

“More robust trials to identify which patients would benefit most and have the most durable remission are needed,” Johnston said.

Based on the available evidence, he said, a pattern is emerging that can help predict who might be a good candidate for the procedure. Patients who develop psoriasis under the age of 40, and who experience worse symptoms following a sore throat, appear most likely to benefit from tonsillectomy, according to Johnston.


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