title: Effect of tonsillectomy on psoriasis: a systematic review.
abstract: BACKGROUND
  Streptococcal infection is associated with psoriasis onset in some patients. Whether tonsillectomy decreases psoriasis symptoms requires a systematic review of the literature.
  
  
  OBJECTIVE
  We sought to determine whether tonsillectomy reduces psoriasis severity through a comprehensive search of over 50 years of literature.
  
  
  METHODS
  We searched MEDLINE, CINAHL, Cochrane, EMBASE, Web of Science, and OVID databases (from August 1, 1960, to September 12, 2013) and performed a manual search of selected references. We identified observational studies and clinical trials examining psoriasis after tonsillectomy.
  
  
  RESULTS
  We included data from 20 articles from the last 53 years with 545 patients with psoriasis who were evaluated for or underwent tonsillectomy. Of 410 reported cases of patients with psoriasis who underwent tonsillectomy, 290 experienced improvement in their psoriasis. Although some patients who underwent tonsillectomy experienced sustained improvement in psoriasis, others experienced psoriasis relapse after the procedure.
  
  
  CONCLUSIONS
  Fifteen of 20 publications were case reports or series that lacked control groups. Publication bias favoring reporting improved cases needs to be considered.
  
  
  CONCLUSIONS
  Tonsillectomy may be a potential option for patients with recalcitrant psoriasis associated with episodes of tonsillitis. Studies with long-term follow-up are warranted to determine more clearly the extent and persistence of benefit of tonsillectomy in psoriasis.
authors.affiliation: Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Tara D
authors.initials: TD
authors.lastname: Rachakonda
authors.affiliation: Department of Dermatology, University of California at Davis School of Medicine, Sacramento, California.
authors.forename: Jaskaran S
authors.initials: JS
authors.lastname: Dhillon
authors.affiliation: Department of Dermatology, University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Aleksandra G
authors.initials: AG
authors.lastname: Florek
authors.affiliation: Department of Dermatology, University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colorado. Electronic address: aprilarmstrong@post.harvard.edu.
authors.forename: April W
authors.initials: AW
authors.lastname: Armstrong
mesh_terms: D015897:Comorbidity; D006801:Humans; D011565:Psoriasis / Q000145:classification / Q000453:epidemiology / Q000601:surgery*; D012008:Recurrence; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000453:epidemiology*; D014068:Tonsillectomy; D016896:Treatment Outcome
keywords: outcomes research; psoriasis; streptococcal infection; systematic review; tonsillectomy; tonsillitis