Abstract
Streptococcal infections may contribute to psoriasis development, and antistreptococcal treatments are considered potential therapies, but their effectiveness remains uncertain due to limited systematic evidence. Our objective was to analyze antistreptococcal therapies' effectiveness in improving psoriasis. We conducted a systematic review following PRISMA guidelines, evaluating antistreptococcal treatment efficacy in psoriasis patients from PubMed, Scopus, and Embase databases until August 14, 2022. Eligible studies included psoriasis patients undergoing antistreptococcal therapy, regardless of demographics or psoriasis type. 50 studies (1778 patients) were analyzed, with penicillins/aminopenicillins as the most studied antibiotics (21 studies), showing mixed outcomes, some reporting significant improvement in guttate psoriasis, while others showed no significant difference. Rifampin demonstrated positive results in most of ten studies, and macrolides showed varying effectiveness in two studies. Tonsillectomy in 14 studies (409 patients) mainly focusing on guttate and chronic plaque psoriasis showed positive outcomes, indicating improved symptoms and quality of life. Limitations include heterogeneous studies, sampling bias, and quality of evidence. This systematic review reveals limited and varied evidence for systemic antibiotic therapy efficacy in psoriasis treatment, while tonsillectomy emerges as a potentially beneficial antistreptococcal option, urging further well-designed, controlled studies with larger sample sizes and standardized protocols for better comparisons.
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Introduction
Psoriasis is a common skin condition affecting approximately 2% of the population [1]. The association between Streptococcus pyogenes infection and both guttate and plaque psoriasis has been well documented [2]. It is theorized that treating an associated streptococcal infection in a patient with psoriasis will lead to improvement of the psoriasis. However, the effectiveness of treating psoriasis patients who have concurrent streptococcal infection with systemic antibiotics or tonsillectomy is still a matter of debate [3]. Other reviews have been conducted to analyze anti-streptococcal therapy for psoriasis but have only included randomized controlled trials [4]. While randomized controlled trials are considered the gold standard for evaluating treatment efficacy, they have certain limitations, including strict inclusion and exclusion criteria that may limit the generalizability of the findings. Therefore, in this review, we aim to conduct a comprehensive analysis of studies of all designs which evaluate the effectiveness of antistreptococcal therapy in improving psoriasis.
Methods and materials
Literature search
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (338,776) [5]. PubMed, Scopus, and Embase databases were searched from their inception until August 14, 2022. The search strategy was validated by a qualified and experienced healthcare librarian. Two authors independently screened abstracts to determine eligibility for inclusion in the systematic review based on the criteria below. Any disagreements were resolved by a third author.
Inclusion and exclusion criteria
All study designs were considered for inclusion. However, studies had to be original and include patients with any type of psoriatic lesions treated with any form of systemic antibiotics or tonsillectomy. Studies in languages other than English and studies without full text accessible were excluded.
Data extraction
When applicable, the following data were collected from each published study: title, author, year of publication, country, study design, aim of study, randomization, number of participants, sex, mean age, participant withdrawals or exclusions, duration of participation, psoriasis type, psoriasis severity, intervention, dosage, duration of treatment, co-interventions, outcomes, evaluation, and comparison to control. Two authors independently extracted data.
Risk of bias assessment
A risk of bias assessment was performed for each of the included articles. The Cochrane RoB 2.0 tool was used for RCTs, the ROBINS-I tool was used for non-randomized studies, the Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses was used for case–control studies, the JBI Critical Checklist for Case Series was used for case series, and the JBI Critical Checklist for Case Reports was used for case reports [6,7,8,9]. Risk of bias assessment was conducted by one author and verified by a second author.
Results
Our initial search of the literature yielded 2,630 non-duplicate studies for screening. After full-text screening, we narrowed our study pool to 50. Of these 50 studies, 38 studies evaluated the efficacy of systemic antibiotics, while 12 studies evaluated the efficacy of tonsillectomy, and two studies evaluated both (McMillin and Whyte). The studies consisted of 10 randomized controlled trials (RCTs) [10,11,12,13,14,15,16,17,18,19], 3 open-label studies [20,21,22], 1 crossover trial [23], 2 single-arm studies [24, 25], 1 prospective observational study [26], 1 case–control study [27], 1 retrospective questionnaire analysis [28], 2 cohort studies [29, 30], 13 case series [31,32,33,34,35,36,37,38,39,40,41,42,43], and 16 case reports [44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59].
Efficacy of systemic antibiotic therapy
In total, 38 studies with a total of 1,369 patients investigated the efficacy of systemic antibiotic therapy in the treatment of psoriasis (Table 1).
Penicillins/aminopenicillins
Twenty-one studies assessed penicillins/aminopenicillins' effectiveness. Two RCTs [10, 11] investigated penicillin's role in psoriasis treatment. Dogan et al. [10] found no significant PASI score differences in guttate psoriasis patients treated with benzathine phenoxymethylpenicillin (n = 14), erythromycin (n = 14), or no treatment (n = 15). All 43 patients had confirmed streptococcal infection. Conversely, Dogra et al. [11] demonstrated notable PASI improvement in moderate-to-severe chronic plaque psoriasis (n = 50) with penicillin treatment (400 mg twice daily for 12 weeks) compared to placebo (n = 50), without testing for streptococcal infection. An open-label study [20] by Caca-Biljanovska et al. showed no significant difference in mean PASI change for guttate psoriasis patients treated with penicillin (n = 10) alongside steroids and phototherapy, compared to without penicillin (n = 10). Two single-arm trials [24, 25] found penicillin effective: Masood et al. [24] in acute guttate psoriasis (n = 100; 80% cleared) and exacerbations (n = 80; 50% cleared), and Saxena et al. [25] in chronic plaque psoriasis (n = 30), with positive ASO titers in 50% and streptococcus cultures in 7%. Bedi et al. [29] found improvement in guttate psoriasis (n = 4) with penicillin (130 mg thrice daily) and confirmed throat streptococcal infection, but lesions often recurred post-treatment. Five [31, 33, 35, 36, 39] of six case series showed positive penicillin outcomes, while one [34] reported ineffectiveness for guttate psoriasis. Eight case reports [45,46,47,48,49,50,51, 53] noted psoriasis resolution with penicillin, amoxicillin, or amoxicillin-clavulanate, but one [54] didn't respond to amoxicillin. McMillin et al.’s [33] case series lacked streptococcal testing. Remaining case series and reports confirmed streptococcal infection by culture or serology.
Rifampin
Ten studies assessed rifampin's efficacy for improving psoriasis. Grozdev et al. [12] found rifampin significantly more effective than placebo in treating guttate psoriasis (p < 0.005), regardless of streptococcal infection. Notably, 12% of chronic plaque psoriasis patients achieved PASI 75 after 60 days. In another study by Grozdev et al. [13], 78% of guttate psoriasis patients with streptococcal infection achieved PASI 75 with rifampin vs. 72% without, compared to 41% with chronic plaque psoriasis and 20% with placebo. Tsankov et al. [15] demonstrated rifampin's superiority over placebo in reducing mean PASI for guttate psoriasis (p < 0.005), irrespective of streptococcal infection. Tsankov et al. [16] had similar findings using Physician Global Assessment (PGA). Vincent et al. [17] showed no clinical change with rifampin or placebo combined with penicillin V/erythromycin for guttate psoriasis (n = 20), despite streptococcal colonization evidence. In an open-label trial, Tsankov et al. [22] showed PASI improvement with rifampin, regardless of streptococcal infection (p < 0.001). Case series [32, 36, 38], and a case report [45] displayed positive responses to rifampin in streptococcal-infected psoriasis patients. Masood et al. [32] included 60 patients without streptococcal testing. Tsankov et al. [38] included 10 patients, 6 with confirmed streptococcal infection. The remaining cases had confirmed streptococcal infection by culture/serology.
Other systemic antibiotics
Two randomized controlled trials (RCTs) assessed macrolides' efficacy in improving psoriasis. In an RCT by Dogan et al. [10], erythromycin showed no significant improvement in PASI. Another RCT by Saxena et al. [14] examined azithromycin (n = 30) and vitamin C tablets (n = 20) in chronic plaque psoriasis patients. After 48 weeks, the azithromycin group displayed a notable mean PASI change (21.65 ± 0.83) versus the vitamin C group (0.40 ± 0.83) (p < 0.001). ASO titers were > 200 IU/ml in 54% of patients. Polat et al. [21] conducted an open-label trial comparing erythromycin and topical steroids to steroids alone. The treatment group (n = 36) showed a statistically significant mean PASI change (8.57 ± 2.90) compared to the control group (n = 24) (p = 0.03). Streptococcal culture was positive for 2 patients in the treatment arm. In a crossover trial by Ward et al. [23] on palmoplantar pustulosis patients (n = 60), clomocycline and placebo were examined, with 37% non-response, 25% preference for clomocycline, and 3% for placebo. Streptococcal infection was not reported. Farrell et al. [27] conducted a case–control study on guttate psoriasis patients (n = 230) treated with antibiotics (n = 78) versus controls (n = 152) with ASO titers > 200 IU/ml in all. Various antibiotics were used, including penicillin (40%), macrolide (28%), cephalosporin (25.5%), and others (6.5%). Antibiotics did not significantly affect time to clearance compared to controls (χ2 = 0.92, p = 0.82). Four case series [31, 34, 36, 37] on erythromycin/terramycin for streptococcal-induced guttate psoriasis reported positive outcomes. Additionally, five case reports [44, 46, 52, 55, 56] demonstrated positive results for cephalexin, clindamycin, and erythromycin. All cases confirmed streptococcal infection by culture or serology.
Efficacy of tonsillectomy
In 14 studies involving 409 patients (Table 2), the efficacy of tonsillectomy for psoriasis treatment was assessed. Thorleifsdottir et al. [18] conducted an RCT comparing tonsillectomy (n = 15) with control (n = 14) in chronic plaque psoriasis patients with a history of psoriasis exacerbation after throat infections. Without streptococcal testing, 13 of 15 participants showed 30–90% reduction in PASI score, with 50% lesion reduction in 9 of 15. The control group demonstrated no improvement; 86% used topical treatment vs. 27% in the treatment group. Similarly, Thorleifsdottir et al. [19] noted reduced Psoriasis Disability Index (PDI) in treatment over time (p = 0.026) and vs. controls (p = 0.037). Ueda et al. [26] prospectively studied post-tonsillectomy pustulosis palmaris et plantaris (PPP, n = 33) using skin severity scores (SSS); post-tonsillectomy mean SSS was 3.5 ± 2.2. Nyfors et al. [28] retrospectively analyzed 74 psoriasis vulgaris patients; after tonsillectomy, 32% cleared, 39% improved, 22% unchanged, 7% worsened. Takahara et al. [30] assessed 138 PPP patients post-tonsillectomy for SSS (n = 138) and Palmoplantar Pustulosis Psoriasis Area Severity Index (PPPASI)(n = 80); 44% and 78% showed complete improvement at 12 and 24 months, respectively, with 70% and 95% seeing 80% + improvement. Fifty percent of patients had positive ASO antibodies. Six case series [33, 39,40,41,42,43] demonstrated tonsillectomy's efficacy, mainly in streptococcal-associated guttate and chronic plaque psoriasis. Two case reports [57, 58] detailed guttate psoriasis patients; psoriasis resolved post-tonsillectomy. One case report [59] investigated plaque psoriasis; PASI reduced from 26.8 to 1 after tonsillectomy. The remaining case series and reports included patients with confirmed streptococcal infection via culture or serology.
Discussion
The findings of this review suggest a potential role of systemic antibiotic therapy in the treatment of psoriasis, particularly guttate psoriasis, with or without confirmed streptococcal infection. Among 38 studies assessing systemic antibiotics' efficacy in psoriasis treatment, penicillins/aminopenicillins were most studied (21 studies). In the largest RCT, Dogra et al. [11] demonstrated significant improvement in PASI scores with penicillin treatment compared to placebo. Two studies [24, 25] without control arms reported marked improvement in guttate psoriasis with penicillins. The effect size of the improvement in outcomes after treatment with penicillins was modest in the largest RCT, which may explain why the two smaller studies [10, 20] with controls were not powered to detect a difference in outcomes. Additional larger studies with control groups are needed to confirm penicillin antibiotics' benefit in psoriasis treatment. Studies should stratify outcomes based on confirmed streptococcal infection presence, providing insight into antibacterial or anti-inflammatory effects.
Rifampin, evaluated in ten studies (including five RCTs), demonstrated effectiveness in treating psoriasis, particularly in guttate psoriasis. The RCTs conducted by Grozdev et al. [12, 13] both reported positive outcomes, with rifampin showing superiority over placebo in improving PASI scores. However, both studies showed no statistical difference in improvement when patients with confirmed streptococcal infection were compared to those without. Likewise, the RCTs by Tsankov et al. [15, 16] showed significant improvement in PASI and PGA respectively for psoriasis patients treated with rifampin compared to placebo. In both studies, there was no significant difference in the response to rifampin comparing patients with guttate psoriasis with and without concomitant infection. This suggests that rifampin's positive outcomes are independent of a psoriasis patient's concurrent streptococcal infection. One possible rationale behind this independent influence could be attributed to rifampin's anti-inflammatory attributes rather than its antimicrobial properties [60]. In dermatology, antibiotics, especially tetracyclines, are extensively employed for their anti-inflammatory rather than antibacterial traits [61]. Although primarily used to treat conditions like acne and hidradenitis suppurativa, these anti-inflammatory effects could potentially yield benefits in psoriasis as well.
Macrolides, evaluated in two RCTs and one case–control study, showed mixed results. Azithromycin demonstrated significant PASI improvement [14], while erythromycin's effect was inconclusive due to small sample sizes [10] and potential confounding by concurrent phototherapy [27].
Tonsillectomy's potential as a treatment for psoriasis was assessed across 14 studies, indicating favorable effects on patients with chronic plaque psoriasis and guttate psoriasis. Notably, Thorleifsdottir et al. [18] conducted an RCT revealing improved PASI scores in chronic plaque psoriasis patients post tonsillectomy. Additionally, another study by Thorleifsdottir et al. [19] exhibited a noteworthy reduction in Psoriasis Disability Index (PDI), indicating improved quality of life. While streptococcal infection confirmation was lacking, patients in these studies showed psoriasis exacerbation post throat infections. Observational studies demonstrated psoriasis symptom amelioration after tonsillectomy in cases of psoriasis vulgaris and recurrent tonsillitis. Similarly, Ueda et al. [26] found reduced mean SSS in PPP patients, and Takahara et al. [30] noted significant SSS and PPPASI score improvements at 12- and 24-months post tonsillectomy. Positive outcomes were also reported in case series and reports.
The evidence compiled in this review is mixed. Several studies demonstrated improved outcomes with various systemic antibiotics, especially in patients with guttate psoriasis. However, these studies exhibited significant variability in the antibiotics and dosages used. Future studies should compare the efficacy of varying doses of different antibiotics to identify an optimal treatment regimen for patients with guttate psoriasis. Furthermore, these studies should compare outcomes in patients with and without concurrent streptococcal infection. Although limited to studies with rifampin, current studies show no difference in benefit from antibiotics between patients with and without concurrent confirmed streptococcal infection. It may be the case that patients with guttate psoriasis benefit from antibiotic treatment regardless of their streptococcal infection status, making the common practice of testing for streptococcal infection in these patients unnecessary. When considering the repeated use of antibiotics for patients with recurrent streptococcal infections, it is important to carefully evaluate and weigh the risk of developing antibiotic resistance [62]. The studies discussed in this review that assess the efficacy of tonsillectomy in patients with psoriasis suggest that it is beneficial in improving outcomes. Further studies are warranted to determine at what threshold a patient with psoriasis and recurrent streptococcal infections should be considered for tonsillectomy. Given the morbidity associated with tonsillectomy, it is important to weigh the risks of a tonsillectomy against the potential benefit to be gained in improving a patient’s psoriasis.
Several limitations warrant consideration when interpreting the findings from this systematic review. Firstly, the included studies displayed heterogeneity in study design, patient attributes, treatment protocols, and outcome gauges. While enhancing generalizability, this heterogeneity limits the strength of assertions regarding the effectiveness of individual antistreptococcal treatments within distinct patient populations. Secondly, evident sampling bias arises from tonsillectomy studies solely encompassing patients with recurrent streptococcal infections, whereas certain antibiotic studies scrutinized patients lacking confirmed streptococcal infections. Thirdly, the quality of evidence exhibited variation among the encompassed studies, primarily consisting of observational studies and case reports. This limitation highlights the need for larger, controlled studies of antistreptococcal treatment in psoriasis.
Conclusion
This systematic review compiles the evidence for efficacy of antistreptococcal treatments, specifically systemic antibiotics and tonsillectomy, in the management of psoriasis. The findings suggest that systemic antibiotic therapy improves outcomes in psoriasis, especially guttate psoriasis and is not dependent on the presence of streptococcal infection. The antibiotic regimens used varied significantly, including penicillins, rifampin, and macrolides. Further research is required to identify an optimal systemic antibiotic treatment regimen for patients with psoriasis. Tonsillectomy showed efficacy in improving psoriasis and quality of life in patients in multiple studies. Further studies should delineate the patient population whose benefit from tonsillectomy outweighs the procedures associated risks.
References
Boehncke WH, Schön MP (2015) Psoriasis. Lancet 386(9997):983–994. https://doi.org/10.1016/S0140-6736(14)61909-7
Zhou S, Yao Z (2022) Roles of Infection in Psoriasis. Int J Mol Sci 23(13):6955
Mehlis, S. Guttate psoriasis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. (Accessed on February 23, 2023.)
Dupire G, Droitcourt C, Hughes C, Le Cleach L (2019) Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database Syst Rev 3(3):011571
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. https://doi.org/10.1136/bmj.b2535
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng H-Y, Corbett MS, Eldridge SM, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898
Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. https://doi.org/10.1136/bmj.i4919
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. Available from: URL: http://www.ohri.ca/programs/clinical_epidemiology/ oxford.htm [cited 2023 Apr 9]
Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, Currie M, Qureshi R, Mattis P, Lisy K, Mu P-F. Chapter 7: Systematic reviews of etiology and risk. In: Aromataris E, Munn Z (Editors). Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute, 2017. Available from https://reviewersmanual.joannabriggs.org
Dogan B, Karabudak O, Harmanyeri Y. Antistreptococcal treatment of guttate psoriasis: A controlled study. International journal of dermatology. 2008;47(9):950–952. https://api.istex.fr/ark:/67375/WNG-63DF05H6-Z/fulltext.pdf. https://doi.org/10.1111/j.1365-4632.2008.03663.x
Dogra L, Dogra J (2019) Long-term oral penicillin in chronic plaque psoriasis (CPP): A randomized controlled trial. 24th World Congress of Dermatology Milan 2019 Abstracts Book
Grozdev I, Kazandjieva J, Tsankov N (2010) New insights of rifampicin in psoriasis. J Eur Acad Dermatol Venereol 24:11–12
Grozdev I, Tsankov N (2016) Rifampicin-more than 20-year experience of its use in psoriasis. Journal of the European Academy of Dermatology and Venereology. 2016;30(S6):3–25. https://api.istex.fr/ark:/67375/WNG-SCLMQBP0-9/fulltext.pdf. https://doi.org/10.1111/jdv.13709
Saxena VN, Dogra J. Long-term oral azithromycin in chronic plaque psoriasis: A controlled trial. EJD. European journal of dermatology. 2010;20(3):329–333. https://www.ncbi.nlm.nih.gov/pubmed/20299307. https://doi.org/10.1684/ejd.2010.0930
Tsankov N, Grozdev I. Rifampicin: A mild immunosuppressive agent for psoriasis. The Journal of dermatological treatment. 2011;22(2):62–64. https://www.tandfonline.com/doi/abs/https://doi.org/10.3109/09546630903496975
Tsankov N, Grozdev I, Kkzandjieva J. Old drug: new indication. rifampicin in psoriasis. The Journal of dermatological treatment. 2006;17(1):18–23. https://www.tandfonline.com/doi/abs/https://doi.org/10.1080/09546630500375643
Vincent F, Ross JB, Dalton M, Wort AJ (1992) A therapeutic trial of the use of penicillin V or erythromycin with or without rifampin in the treatment of psoriasis. J Am Acad Dermatol 26(3):458–461. https://doi.org/10.1016/0190-9622(92)70072-N
Thorleifsdottir RH, Sigurdardottir SL, Sigurgeirsson B, et al. Improvement of psoriasis after tonsillectomy is associated with a decrease in the frequency of circulating T cells that recognize streptococcal determinants and homologous skin determinants. The Journal of immunology (1950). 2012;188(10):5160–5165. https://www.ncbi.nlm.nih.gov/pubmed/22491250. https://doi.org/10.4049/jimmunol.1102834
Thorleifsdottir RH, Sigurdardottir SL, 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 dermato-venereologica. 2017;97(3):340–345. https://www.ncbi.nlm.nih.gov/pubmed/27819714. https://doi.org/10.2340/00015555-2562
Caca-Biljanovska NG, V'lckova-Laskoska MT. Management of guttate and generalized psoriasis vulgaris: Prospective randomized study. Croatian medical journal. 2002;43(6):707–712. https://www.ncbi.nlm.nih.gov/pubmed/12476481
Polat M, Lenk N, Yalcin B, et al. Efficacy of erythromycin for psoriasis vulgaris. Clinical and experimental dermatology. 2007;32(3):295–297. http://www.ingentaconnect.com/content/bsc/ced/2007/00000032/00000003/art00015. https://doi.org/10.1111/j.1365-2230.2007.02370.x
Tsankov N, Grozdev I. Rifampicin in the treatment of psoriasis. Journal of the European Academy of Dermatology and Venereology. 2009;23(1):93–95. https://api.istex.fr/ark:/67375/WNG-3JKMFVCH-V/fulltext.pdf. https://doi.org/10.1111/j.1468-3083.2008.02721.x.
Ward JM, Corbett MF, Hanna MJ. A double-blind trial of clomocycline in the treatment of persistent palmoplantar pustulosis. British journal of dermatology (1951). 1976;95(3):317–322. https://api.istex.fr/ark:/67375/WNG-4971FZPV-7/fulltext.pdf. https://doi.org/10.1111/j.1365-2133.1976.tb07020.x
Masood Q, Sheikh M. Treatment of psoriasis with penicillin. JK Pract. 1997;4:178–179.
Saxena VN, Dogra J. Long-term use of penicillin for the treatment of chronic plaque psoriasis. EJD. European journal of dermatology. 2005;15(5):359–362. https://www.ncbi.nlm.nih.gov/pubmed/16172045
Ueda S, Takahara M, Tohtani T, Yoshizaki T, Kishibe K, Harabuchi Y. Up-regulation of ß1 integrin on tonsillar T cells and its induction by in vitro stimulation with α-streptococci in patients with pustulosis palmaris et plantaris. J Clin Immunol. 2010;30(6):861–871. https://agris.fao.org/agris-search/search.do?recordID=US201301907703. https://doi.org/10.1007/s10875-010-9451-0
Farrell J, Stewart TJ, Rosen RH. Does antibiotic therapy affect time to clearance in post-active phase streptococcal guttate Psoriasis—A case control study. Journal of psoriasis and psoriatic arthritis. 2021;6(1):43–44. https://journals.sagepub.com/doi/full/https://doi.org/10.1177/2475530320975380
Nyfors A, Rasmussen PA, Lemholt K, Eriksen B (1976) Improvement of recalcitrant psoriasis vulgaris after tonsillectomy. J Laryngol Otol 90(8):789–794. https://doi.org/10.1017/S0022215100082694
Bedi TR (1979) Psoriasis in children. Indian J Dermatol Venereol Leprol 45(6):410–413
Takahara M, Hirata Y, Nagato T, et al. Treatment outcome and prognostic factors of tonsillectomy for palmoplantar pustulosis and pustulotic arthro‐osteitis: A retrospective subjective and objective quantitative analysis of 138 patients. Journal of dermatology. 2018;45(7):812–823. https://onlinelibrary.wiley.com/doi/abs/https://doi.org/10.1111/1346-8138.14348
Honig PJ (1988) Guttate psoriasis associated with perianal streptococcal disease. J Pediatr 113(6):1037–1039. https://doi.org/10.1016/S0022-3476(88)80577-8
Masood Q, Manzoor S, Rukhsana A. Treatment of acute guttate psoriasis with rifampicin. Indian journal of dermatology, venereology, and leprology. 2000;66(6):296–298. https://www.ncbi.nlm.nih.gov/pubmed/20877106
McMillin BD, Maddern BR, Graham WR. A role for tonsillectomy in the treatment of psoriasis? Ear, nose, and throat journal. 1999;78(3):155–158. https://journals.sagepub.com/doi/full/https://doi.org/10.1177/014556139907800308
Patrizi A, Costa AM, Fiorillo L, Neri I. Perianal streptococcal dermatitis associated with guttate psoriasis and/or balanoposthitis: A study of five cases. Pediatric dermatology. 1994;11(2):168–171. https://api.istex.fr/ark:/67375/WNG-1RFS040B-2/fulltext.pdf. https://doi.org/10.1111/j.1525-1470.1994.tb00574.x
Rehder PA, Eliezer ET, Lane AT. Perianal cellulitis. Archives of dermatology (1960). 1988;124(5):702–704. https://doi.org/10.1001/archderm.1988.01670050046018
Rosenberg EW, Noah PW, Zanolli MD, Skinner RBJ, Bond MJ, Crutcher N. Use of rifampin with penicillin and erythromycin in the treatment of psoriasis. Journal of the American Academy of Dermatology. 1986;14(5):761–764. https://www.ncbi.nlm.nih.gov/pubmed/3086388
Stokes JH, Ford WT (1951) Observations on treatment mechanisms in psoriasis with special reference to terramycin. J Investig Dermatol 17(3):171–176. https://doi.org/10.1038/jid.1951.78
Tsankov N, Krasteva M. Rifampicin therapy in severe forms of psoriasis. The Journal of dermatological treatment. 1992;3(2):69–71. https://www.tandfonline.com/doi/abs/https://doi.org/10.3109/09546639209089062
Whyte HJ, Baughman RD. Acute guttate psoriasis and streptococcal infection. Archives of dermatology (1960). 1964;89(3):350–356. https://doi.org/10.1001/archderm.1964.01590270036008
Hone SW, Donnelly MJ, Powell F, Blayney AW. Clearance of recalcitrant psoriasis after tonsillectomy. Clinical otolaryngology. 1996;21(6):546–547. https://api.istex.fr/ark:/67375/WNG-4DK1V35Z-0/fulltext.pdf. https://doi.org/10.1111/j.1365-2273.1996.tb01108.x
Saita B, Ishii Y, Ogata K, Kikuchi I, Inoue S, Naritomi K. Two sisters with guttate psoriasis responsive to tonsillectomy: Case reports with HLA studies. Journal of dermatology. 1979;6(3):185–189. https://www.ncbi.nlm.nih.gov/pubmed/393748. https://doi.org/10.1111/j.1346-8138.1979.tb01898.x
Thorleifsdottir RH, Eysteinsdóttir JH, Olafsson JH, et al. Throat infections are associated with exacerbation in a substantial proportion of patients with chronic plaque psoriasis. Acta dermato-venereologica. 2016;96(6):788–791. https://www.ncbi.nlm.nih.gov/pubmed/26984718. https://doi.org/10.2340/00015555-2408
Thorleifsdottir RH, MD, Sigurdardottir SL, PhD, Sigurgeirsson, Bardur, MD, PhD, et al. HLA-Cw6 homozygosity in plaque psoriasis is associated with streptococcal throat infections and pronounced improvement after tonsillectomy: A prospective case series. Journal of the American Academy of Dermatology. 2016;75(5):889–896. https://www.clinicalkey.es/playcontent/1-s2.0-S0190962216304820. https://doi.org/10.1016/j.jaad.2016.06.061
Banno T, Fujisawa H, Satomi H, Imakado S, Otsuka F. Psoriasis vulgaris and acute guttate psoriasis in a family. International journal of dermatology. 2001;40(4):285–287. https://api.istex.fr/ark:/67375/WNG-408T48GR-D/fulltext.pdf. https://doi.org/10.1046/j.1365-4362.2001.01212-3.x
Belew-Noah PW, Rosenberg WE, Zabriskie JB, Skinner RB, Henson TH, Beard GB. Microbial associations and response to antimicrobials seen in a psoriasis clinic. Advances in experimental medicine and biology. 1997;418:157–159. http://link.springer.com/https://doi.org/10.1007/978-1-4899-1825-3_38
Cassandra M, Conte E, Cortez B. Childhood pustular psoriasis elicited by the streptococcal antigen: A case report and review of the literature. Pediatric dermatology. 2003;20(6):506–510. https://onlinelibrary.wiley.com/doi/abs/https://doi.org/10.1111/j.1525-1470.2003.20611.x
Garritsen FM, Kraag DE, Graaf M. Guttate psoriasis triggered by perianal streptococcal infection. Clinical and experimental dermatology. 2017;42(5):536–538. https://onlinelibrary.wiley.com/doi/abs/https://doi.org/10.1111/ced.13129
Guidetti MS, Peluso AM, Piraccini BM, Tosti A (1994) Acute palmoplantar pustulosis: A case report. Ann Ital Dermatol Clin Sper 48:175–177
Herbst RA, Hoch O, Kapp A, Weiss J (2000) Guttate psoriasis triggered by perianal streptococcal dermatitis in a four-year-old boy. J Am Acad Dermatol 5(42):885–887. https://doi.org/10.1016/S0190-9622(00)90263-9
Hoffmann TJ, Kettler A, Bruce S. Acute acral pustulosis. British journal of dermatology (1951). 1989;120(1):107–111. https://api.istex.fr/ark:/67375/WNG-LRG73849-C/fulltext.pdf. https://doi.org/10.1111/j.1365-2133.1989.tb07772.x
Horner KL, Chien AJ, Edenholm M, Hornung RL. Winnie the pooh and psoriasis too: An isomorphic response of guttate psoriasis in a tattoo. Pediatric dermatology. 2007;24(5):E70-E72. https://onlinelibrary.wiley.com/doi/abs/https://doi.org/10.1111/j.1525-1470.2007.00445.x
Maiolo C, Kwok SM, Ross C, Ibbetson J (2016) Perianal streptococcal infection precipitating pustular psoriasis in an adult. JAAD Case Reports 2(4):281–283. https://doi.org/10.1016/j.jdcr.2016.05.010
Pacifico L, Renzi AM, Chiesa C. Acute guttate psoriasis after streptococcal scarlet fever. Pediatric dermatology. 1993;10(4):388–389. https://api.istex.fr/ark:/67375/WNG-8NJ3LVRT-F/fulltext.pdf. https://doi.org/10.1111/j.1525-1470.1993.tb00409.x
Rasi A, Pour-Heidari N. Association between plaque-type psoriasis and perianal streptococcal cellulitis and review of the literature. Archives of Iranian medicine. 2009;12(6):591. https://www.ncbi.nlm.nih.gov/pubmed/19877754
Romano I, Venturi C, Bassissi P (2002) Perianal streptococcal dermatitis and guttate psoriasis. Eur J Pediatr Dermatol 12:93–96
Shelley WB, Wood MG, Beerman H (1975) Pustular psoriasis elicited by streptococcal antigen and localized to the sweat pore. J Investig Dermatol 65(5):466–471. https://doi.org/10.1111/1523-1747.ep12608210
Cohn JE, Pfeiffer M, Vernose G. Complete resolution of guttate psoriasis after tonsillectomy. Ear, nose, & throat journal. 2018;97(3):62–63. https://journals.sagepub.com/doi/full/https://doi.org/10.1177/014556131809700319
Loyal J, Flores S, Alikhan A. Resolution of psoriasis after tonsillectomy. Dermatology online journal. 2017;23(2). https://www.ncbi.nlm.nih.gov/pubmed/28329505. https://doi.org/10.5070/D3232033979
Simões JF, Ribeiro J, Ferreira BR, Paiva S. The role of tonsillectomy in psoriasis treatment. BMJ case reports. 2015;2015(jan30 1):bcr2014206899. https://doi.org/10.1136/bcr-2014-206899
Ziglam HM, Daniels I, Finch RG (2004) Immunomodulating activity of rifampicin. J Chemother 16(4):357–361. https://doi.org/10.1179/joc.2004.16.4.357
Humbert P, Treffel P, Chapuis JF, Buchet S, Derancourt C, Agache P (1991) The tetracyclines in dermatology. J Am Acad Dermatol 25(4):691–697. https://doi.org/10.1016/0190-9622(91)70255-z
Duong QA, Pittet LF, Curtis N, Zimmermann P (2022) Antibiotic exposure and adverse long-term health outcomes in children: a systematic review and meta-analysis. J Infect 85(3):213–300. https://doi.org/10.1016/j.jinf.2022.01.005
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Sitton, B., Walker, T., Mital, R. et al. Antistreptococcal treatment of psoriasis: a systematic review. Arch Dermatol Res 316, 363 (2024). https://doi.org/10.1007/s00403-024-03051-8
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DOI: https://doi.org/10.1007/s00403-024-03051-8