Features of tonsillitis-related psoriasis:
(1) The patient has psoriasis, usually guttate or chronic plaque types.
(2) The psoriasis has responded poorly to appropriate treatment.
(3) The patient has recurrent episodes of tonsillitis.
(4) The activity of the psoriasis increases during episodes of tonsillitis.
(5) The psoriasis significantly improves or disappears after tonsillectomy.
Various theories proposed:
(1) Activation of T-cells in the tonsils.
(2) Immune response to Streptococcal species causing the tonsillitis.
(3) Triggering of psoriasis by the host inflammatory response.
One issue is whether the "psoriasis" is true psoriasis or a different skin disorder. Streptococcal tonsillitis is associated with palmoplantar pustulosis. Perhaps another type of streptococcal skin reaction has been misdiagnosed as psoriasis.
Tonsillectomy may be beneficial for selected patients but it remains to be proven that it is effective for most patients with psoriasis.
