Advertisement

Tonsillectomy and the subsequent risk of psoriasis: A nationwide population-based cohort study

Published:February 03, 2021DOI:https://doi.org/10.1016/j.jaad.2021.01.094

      Background

      Tonsillectomy has been suggested as an intervention to resolve psoriasis.

      Objective

      This study aimed to investigate the subsequent risk of psoriasis in patients who received tonsillectomy.

      Methods

      We used data from the Taiwan National Health Insurance Research Database. The tonsillectomy group (case group) and the tonsillectomy-free group (comparison group) were matched at a ratio of 1:4 by demographic data, comorbidities, medical confounders, and the index date. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

      Results

      We identified 2021 patients as the case group and matched 8084 individuals as the comparison group. The adjusted HR (aHR) of psoriasis was 0.43 (95% CI, 0.22-0.87; P < .05). The study population is composed of a mainly male (65%) and young population (mostly younger than 50 years). Notably, patients with rheumatoid arthritis increased the risk of psoriasis (aHR, 3.97; 95% CI, 1.17-13.48; P < .05). In our stratification analysis, the risk of psoriasis decreased in almost all subgroups.

      Limitation

      Our database did not include information on genome and the subtypes of psoriasis.

      Conclusion

      Our study showed a decreased risk of psoriasis in the tonsillectomy group after adjustment for baseline characteristics, comorbidities, and medical confounders compared with the reference group.

      Key words

      Abbreviations used:

      aHR (adjusted hazard ratio), CI (confidence interval), GAS (group A Streptococcus), HR (hazard ratio), ICD-9-CM (International Statistical Classification of Diseases and Related Health Problems, Ninth Revision, Clinical Modification), LHIRD (Longitudinal Health Insurance Research Dataset), NHIRD (National Health Insurance Research Database)
      To read this article in full you will need to make a payment
      AAD Member Login
      AAD Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Parisi R.
        • Symmons D.P.
        • Griffiths C.E.
        • Ashcroft D.M.
        Global epidemiology of psoriasis: a systematic review of incidence and prevalence.
        J Invest Dermatol. 2013; 133: 377-385
        • Wang Y.
        • Liang Y.
        • Li J.
        • et al.
        Expression and functional regulation of gap junction protein connexin 43 in dermal mesenchymal stem cells from psoriasis patients.
        Acta Histochem. 2020; 122: 151550
        • Bronckers I.M.
        • Paller A.S.
        • van Geel M.J.
        • van de Kerkhof P.C.
        • Seyger M.M.
        Psoriasis in children and adolescents: diagnosis, management and comorbidities.
        Paediatr Drugs. 2015; 17: 373-384
        • Allen H.B.
        • Jadeja S.
        • Allawh R.M.
        • Goyal K.
        Psoriasis, chronic tonsillitis, and biofilms: tonsillar pathologic findings supporting a microbial hypothesis.
        Ear Nose Throat J. 2018; 97: 79-82
        • De Jesús-Gil C.
        • Sans-de San Nicolás L.
        • Ruiz-Romeu E.
        • et al.
        Specific IgA and CLA(+) T-cell IL-17 response to Streptococcus pyogenes in psoriasis.
        J Invest Dermatol. 2020; 140: 1364-1370
        • Ruiz-Romeu E.
        • Ferran M.
        • Sagristà M.
        • et al.
        Streptococcus pyogenes-induced cutaneous lymphocyte antigen-positive T cell-dependent epidermal cell activation triggers TH17 responses in patients with guttate psoriasis.
        J Allergy Clin Immunol. 2016; 138: 491-499
        • Chen S.
        • Wang W.W.
        • Wang Y.
        • Li Y.Q.
        • Zhu L.X.
        Cellular senescence in recurrent tonsillitis and tonsillar hypertrophy in children.
        Int J Pediatr Otorhinolaryngol. 2020; 133: 110004
        • Darrow D.H.
        • Siemens C.
        Indications for tonsillectomy and adenoidectomy.
        Laryngoscope. 2002; 112: 6-10
        • Thorleifsdottir R.H.
        • Sigurdardottir S.L.
        • Sigurgeirsson B.
        • et al.
        Patient-reported outcomes and clinical response in patients with moderate-to-severe plaque psoriasis treated with tonsillectomy: a randomized controlled trial.
        Acta Derm Venereol. 2017; 97: 340-345
        • Loyal J.
        • Flores S.
        • Alikhan A.
        Resolution of psoriasis after tonsillectomy.
        Dermatol Online J. 2017; 23: 13030
        • Cohn J.E.
        • Pfeiffer M.
        • Vernose G.
        Complete resolution of guttate psoriasis after tonsillectomy.
        Ear Nose Throat J. 2018; 97: 62-63
        • Simões J.F.
        • Ribeiro J.
        • Ferreira B.R.
        • Paiva S.
        The role of tonsillectomy in psoriasis treatment.
        BMJ Case Rep. 2015; 2015 (bcr2014206899)
        • Thorleifsdottir R.H.
        • Sigurdardottir S.L.
        • Sigurgeirsson B.
        • et al.
        HLA-Cw6 homozygosity in plaque psoriasis is associated with streptococcal throat infections and pronounced improvement after tonsillectomy: a prospective case series.
        J Am Acad Dermatol. 2016; 75: 889-896
        • McMillin B.D.
        • Maddern B.R.
        • Graham W.R.
        A role for tonsillectomy in the treatment of psoriasis?.
        Ear Nose Throat J. 1999; 78: 155-158
        • Wu W.
        • Debbaneh M.
        • Moslehi H.
        • Koo J.
        • Liao W.
        Tonsillectomy as a treatment for psoriasis: a review.
        J Dermatolog Treat. 2014; 25: 482-486
        • Rachakonda T.D.
        • Dhillon J.S.
        • Florek A.G.
        • Armstrong A.W.
        Effect of tonsillectomy on psoriasis: a systematic review.
        J Am Acad Dermatol. 2015; 72: 261-275
        • Sigurdardottir S.L.
        • Thorleifsdottir R.H.
        • Valdimarsson H.
        • Johnston A.
        The association of sore throat and psoriasis might be explained by histologically distinctive tonsils and increased expression of skin-homing molecules by tonsil T cells.
        Clin Exp Immunol. 2013; 174: 139-151
        • Valdimarsson H.
        • Thorleifsdottir R.H.
        • Sigurdardottir S.L.
        • Gudjonsson J.E.
        • Johnston A.
        Psoriasis—as an autoimmune disease caused by molecular mimicry.
        Trends Immunol. 2009; 30: 494-501
        • Haapasalo K.
        • Koskinen L.L.E.
        • Suvilehto J.
        • et al.
        The psoriasis risk allele HLA-C∗06:02 shows evidence of association with chronic or recurrent streptococcal tonsillitis.
        Infect Immun. 2018; 86: e00304-e00318
        • Mitchell R.B.
        • Archer S.M.
        • Ishman S.L.
        • et al.
        Clinical practice guideline: tonsillectomy in children (update).
        Otolaryngol Head Neck Surg. 2019; 160: S1-S42
        • Karaman M.
        • Tek A.
        • Tuncel A.
        • Oysu C.
        • Sheidaei S.
        Adult tonsillectomy: relationship between indications and postoperative hemorrhage.
        Kulak Burun Bogaz Ihtis Derg. 2012; 22: 21-25
        • Galindo Torres B.P.
        • De Miguel García F.
        • Whyte Orozco J.
        Tonsillectomy in adults: analysis of indications and complications.
        Auris Nasus Larynx. 2018; 45: 517-521
        • Coates L.C.
        • FitzGerald O.
        • Helliwell P.S.
        • Paul C.
        Psoriasis, psoriatic arthritis, and rheumatoid arthritis: is all inflammation the same?.
        Semin Arthritis Rheum. 2016; 46: 291-304
        • Kirkham B.W.
        • Kavanaugh A.
        • Reich K.
        Interleukin-17A: a unique pathway in immune-mediated diseases: psoriasis, psoriatic arthritis and rheumatoid arthritis.
        Immunology. 2014; 141: 133-142
        • Dupire G.
        • Droitcourt C.
        • Hughes C.
        • Le Cleach L.
        Antistreptococcal interventions for guttate and chronic plaque psoriasis.
        Cochrane Database Syst Rev. 2019; 3: CD011571