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SAN FRANCISCO -- Patients with psoriasis frequently have clinically meaningful improvement in disease status after undergoing tonsillectomy, a review of 410 cases showed.

The retrospective study found that psoriasis improved in 290 of the patients during the brief follow-up period associated with individual cases. Some patients had improvement in psoriasis soon after surgery, and some had prolonged disease-free periods.

However, limited information about the patient populations precluded any definitive statements about the association between tonsillectomy and psoriasis, , of the , and colleagues concluded in a presentation here at the American Academy of Dermatology meeting.

"Based on this comprehensive systematic review on the effect of tonsillectomy on psoriasis, we found that although tonsillectomy is effective in ameliorating psoriasis in a subpopulation of patients, there are insufficient data to describe the differences in clinical characteristics between responders versus nonresponders to tonsillectomy," the authors concluded.

"Clinicians need to evaluate patients on an individual basis and reserve tonsillectomy for patients with recalcitrant and recurrent psoriasis exacerbations clearly associated with chronic tonsillitis."

The study adds to a long but uninformative history regarding an association between psoriasis and tonsillectomy.

"The question of whether tonsillectomy might be helpful to improve the status of psoriasis has long been questioned," said , of the University of Pennsylvania in Philadelphia and a spokesperson for the . "Unfortunately the literature is quite weak, leaving the question still mostly unanswered in my opinion. If you look at the poster, most of the cases are single case reports, and while interesting, not conclusive."

Streptococcal infection has been hypothesized as one potential mechanism for psoriasis etiology and pathogenesis. Conceivably, a streptococcal trigger in the tonsils might activate "skin-homing" T cells to initiate psoriasis.

Florek and colleagues searched medical literature for studies related to tonsillectomy and psoriasis. Their objective was to assess evidence that might support tonsillectomy as a potential treatment option for patients with psoriasis associated with episodes of tonsillitis.

They searched for controlled or observational studies of patients with plaque or guttate psoriasis who underwent tonsillectomy and had at least one follow-up visit after the surgery. Case reports and series were eligible for inclusion.

A search of a half dozen literature databases yielded 674 records, which the authors pared down to 20 studies, consisting of one randomized trial, one retrospective study, four prospective observational studies, seven case reports, and seven case series. The studies involved a cumulative total of 410 patients from eight countries.

The analysis showed that 70% of the patients had improvement in psoriasis following tonsillectomy. The improvement persisted during follow-up that ranged from 2 to 10 months across the studies included in the review.

In addition to prolonged periods free of disease, some patients' psoriasis became more responsive to treatment during flares as compared with treatment experience prior to the surgery.

Florek and colleagues concluded that controlled studies and long-term follow-up are needed to determine the magnitude and duration of benefit of tonsillectomy in patients with psoriasis. In the absence of that information, the surgery should not be considered as a routine option for psoriasis, but the authors did not rule out selected use of tonsillectomy.

"In certain cases, tonsillectomy may be reserved for selected patients with recalcitrant and recurrent psoriasis exacerbations associated with chronic tonsillitis," they concluded.

"Importantly, in patients considering tonsillectomy, clinicians need to inform them of potential adverse events associated with tonsillectomy, including infection, hemorrhage, laryngospasm, bronchospasm, temporomandibular joint dysfunction, and vocal changes. Rare but serious adverse events include airway compromise secondary to edema."

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