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Clinical Review

Managing comorbid disease in patients with psoriasis

BMJ 2010; 340 doi: (Published 15 January 2010) Cite this as: BMJ 2010;340:b5666

Rapid Response:

Tonsillectomy: does it improve the severity of psoriasis?

Tonsillectomy: does it improve the severity of psoriasis?

Tatiana Gutierrez, Stamatios Peridis, Claire Hopkins

Department of Otolaryngology Head and Neck Surgery, Guy’s and St
NHS Trust, London, United Kingdom

Corresponding author
Stamatios Peridis MD, Department of Otolaryngology Head and Neck Surgery,
Guy’s and St Thomas’ NHS Trust, Guy’s Hospital, Great Maze Pond, London,
SE1 9RT, United Kingdom.


Competing interests: None declared.

The clinical review article by Boehncke WH et al, (1) states that
developments have substantially changed the understanding of psoriasis:
TH17 cells (lymphocytes) have been found to be important effectors in
autoimmune diseases, psoriasis is now confirmed as a systematic disease,
and most importantly for the purposes of this letter, psoriasis has been
to frequently occur alongside other diseases. It is our view, that
although the
authors’ associated list of comorbidities in patients with psoriasis is
and extensive, such as metabolic syndromes, Crohn’s disease, cancer,
depression and cardiovascular risks, among others, it does not consider
potential comorbidities such as tonsillitis and there is no mention of
improvement of psoriasis after tonsillectomy.

It is our clinical experience that the severity of psoriasis improves
tonsillectomy. The literature review has confirmed there is sufficient
to support the association. Stukalenko, (2) first established the
connection of
these diseases on a 24-year old male from the patient’s history and
confirmed the cure of the psoriasis after tonsillectomy. Nyfors et al, (3)

conducted a retrospective study of the course of psoriasis after
in 74 patients and the results showed that the clearing of psoriasis
was statistically significant (p<_0.01 as="as" _1="_1" _3="_3" of="of" the="the" patients="patients" obtained="obtained" clearing="clearing" psoriasis="psoriasis" throughout="throughout" entire="entire" follow="follow" up="up" period.="period." wilson="wilson" et="et" al="al" _4="_4" on="on" other="other" hand="hand" reviewed="reviewed" efficacy="efficacy" antibiotic="antibiotic" therapy="therapy" and="and" tonsillectomy="tonsillectomy" treatments="treatments" for="for" childhood="childhood" psoriasis.="psoriasis." percentage="percentage" who="who" experienced="experienced" disease="disease" clearance="clearance" after="after" in="in" an="an" uncontrolled="uncontrolled" trial="trial" was="was" ranged="ranged" from="from" _32="_32" to="to" _53="_53" a="a" similar="similar" reported="reported" significant="significant" improvement="improvement" their="their" with="with" maximum="maximum" _7="_7" noting="noting" worsening="worsening" operation.="operation." p="p"/> Tonsillectomy is one of the most commonly performed operations in
otolaryngology. (5) The national prospective tonsillectomy audit, (6)
confirmed that it is a safe operation with a low incidence of post-
complications. In a patient with recurrent sore throats, the possibility
improving psoriatic control should be noted when considering the role of
operative intervention.


1. Boehncke WH, Boehncke S, Schön MP. Managing comorbid disease in
patients with psoriasis. BMJ 2010;340:b5666.

2. Stukalenko AA. Recovery from psoriasis vulgaris after tonsillectomy.
Otorinolaringol 1967;2:101-102.

3. Nyfors A, Rasmussen PA, Lemholt K, Eriksen B. Improvement of
psoriasis vulgaris after tonsillectomy. J Laryngol Otol 1976; 90:789-794.

4. Wilson JK, Al-Suwaidan SN, Krowchuk D, Feldman SR. Treatment of
psoriasis in children: is there a role for antibiotic therapy and
Pediatr Dermatol 2003;20:11-15.

5. Macfarlane PL, Nasser S, Coman WB, Kiss G, Harris PK, Carney AS.
Tonsillectomy in Australia: an audit of surgical technique and
care. Otolaryngol Head Neck Surg 2008;139:109-114.

6. The Royal College of Surgeons of England. National prospective
tonsillectomy audit, 2005. Available at:, Accessed
on 25 January 2010.

Competing interests:
None declared

Competing interests: No competing interests

27 January 2010
Tatiana Gutierrez
Department of Otolaryngology Head and Neck Surgery
Stamatios Peridis and Claire Hopkins
Guy's and St Thomas' NHS Trust