Sore throats can make plaque psoriasis worse

| Melissa Leavitt

You already know that psoriasis can be a pain in the neck. But could it all start with a pain in your throat?

According to a recent study, the majority of people with psoriasis who also had strep throat experienced a psoriasis flare around the time of their throat infection. And for more than a third of people with plaque psoriasis, sore throats made their psoriasis worse.

The data, published in March in the journal Acta Dermato Venereologica, helps explain the strep-psoriasis connection. Better yet, it offers new clues into the best way to treat patients whose psoriasis is associated with a sore throat.

Scientists have known for a century that strep throat—what scientists call a streptococcal infection—can trigger guttate psoriasis, which appears as small red dots on the skin. But only a few studies have examined the relationship between strep and plaque psoriasis, the most common form of the disease, according to the researchers.

For some patients whose psoriasis is associated with sore throats, removing the tonsils—and the strep bacteria hiding in them—can improve psoriasis. But doctors are still trying to figure out when tonsillectomy is a good treatment option and which psoriasis patients are likely to benefit from it.

Almost half of patients benefited from tonsillectomy

To help answer these questions, researchers gathered a large group of psoriasis patients and gave them a questionnaire asking things like how often they had sore throats or strep throat, whether they experienced any worsening of their psoriasis when they had a sore throat, and if they had a tonsillectomy, whether it helped their psoriasis.

The study involved 275 psoriasis patients in Iceland with roughly equal numbers of men and women.

According to the results, for 42 percent of plaque psoriasis patients, their psoriasis got worse when they had a sore throat. On top of that, 75 percent of patients who had been diagnosed with strep throat experienced worsening of their psoriasis along with the strep.

This group included 72 percent of plaque psoriasis patients and 94 percent of patients with guttate psoriasis, the study found.

In addition, 48 percent of patients who had their tonsils out after getting psoriasis reported that their psoriasis got better afterward.

Psoriasis: collateral damage in the battle against strep?

When you get a strep infection, your immune system responds by increasing the number of immune cells in the tonsils. Some of these immune cells migrate to the skin, where they can contribute to the inflammation seen in psoriasis, the researchers explained.

Psoriasis is an immune-mediated disorder, which means that it’s driven by an immune system response that leads to ongoing inflammation. For people whose psoriasis gets worse after a throat infection, that immune response might have kicked in when their bodies tried to fight off the strep.

Nailing down how many people with psoriasis contend with flares following a bad sore throat can help doctors understand which patients might be good candidates for a tonsillectomy. But, as the researchers concluded, more extensive studies are needed to fully examine the effects of tonsillectomy on psoriasis.

The study was funded in part through a 2015 $75,000 National Psoriasis Foundation Discovery Grant to Dr. Andrew Johnston, a dermatology researcher at the University of Michigan.

Always work with your doctor to find the best way to treat your psoriasis.


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