TONSILLITIS AS A FACTOR IN PSORIASIS FLARE-UPS

Tonsillitis is an inflammation of the tonsils. Recently, scientists have found evidence that inflamed tonsils can influence the occurrence of psoriasis flare-ups in patients. Psoriasis is also an inflammatory condition but this is a skin problem that only recently has been found to be linked to tonsil problems.

Read on to learn about tonsillitis and how this condition really can be an important factor in psoriasis flare-ups.

Tonsils and the Cause of Tonsillitis

The two tonsils are found at the back of the throat; these consist of lymphatic and immune tissue that helps protect the body from infection. Tonsillitis is found most commonly in kids under 15, and it can be caused either by a type of virus or a bacterium.

Viruses such as cytomegalovirus, herpes, and adenovirus can cause tonsillitis. Streptococcus pyogenes is the usual bacterium responsible for infecting and inflaming the tonsils.

There is more than one group of Streptococcus involved in causing illness, and in fact, group A species are most often the cause of strep throat, which can simultaneously infect the tonsils.

One reason that the tonsils are so often affected is that they are part of the immune system and are found in the oral cavity, which is often exposed to pathogens.

The Symptoms of Tonsillitis

The symptoms of tonsillitis include the following:

• Painful throat
• Difficulty and pain when swallowing
• Swollen and red tonsils that may have a white coating on them
• Fever
• Enlarged neck lymph nodes

Causes of Psoriasis

Psoriasis can occur in children under 16 and in adults, including pregnant women. The factors that are believed important in the development of psoriasis are listed below:

• Immune system response involving T cells: The T cells of the skin are activated and interact with the skin cells called keratinocytes. The T cells and other immune responses are triggered by the presence of pathogens. T cells are a type of lymphocyte, a cell of the immune system produced in response to an infection.
• Genetics: There are three specific genes named  CCHCR1, HLA-C, and CDSN that are associated with the development of psoriasis.

How Tonsillitis can Influence Psoriasis

When the tonsils are inflamed, there is a specific immune response that is not the same for everybody. The main reasons why tonsillitis can trigger psoriasis flare-ups are summarized below:

• The T cells activated and present in the tonsils can move to the skin, causing an immune response to occur in the epidermal cells.
• In people who already have psoriasis, tonsil inflammation causes an increased expression of particular T cell receptors. A T cell receptor is a protein found on the membrane of the T cell.

A receptor is a place where chemical messages become attached to bring about a response in a cell. In people with psoriasis, tonsillitis provokes an increase in the expression of the interleukin 23 receptor on the skin lymphocytes.

• There is also an antigen called CLA that occurs on CD4 and CD8 white blood cells. An antigen is a type of protein on the cell. The CLA is also increased in psoriasis patients when their tonsils are inflamed.

Scientists speculate that these changes together increase immune response in the skin, causing patients with psoriasis to experience flare-ups when they have tonsilitis.

Tonsillitis is also linked to the uncommon skin problem known as pustulosis palmaris but not to the more common condition of eczema.

Symptoms of Psoriasis

The symptoms of psoriasis are described below.

• The most obvious sign of psoriasis is the presence of raised patches of skin called plaques.
• The skin patches are often scaly and quite big at more than 1 cm in size. The skin plaques often look reddish and also silvery in color.
• Psoriasis often first develops on the scalp but also occurs on the outside of the elbows and legs.
• The affected skin patches may or may not itch, but they do look unsightly.
• Up to 1/3 of patients with psoriasis also develop arthritis, in which the joints are inflamed and painful.

Factors that Worsen Psoriasis

There are some other factors besides tonsillitis that can further trigger symptoms of psoriasis or at least exacerbate the condition. 

• Stress: Psychological distress can increase the likelihood of psoriasis flaring up.
• Drinking alcohol: Alcohol increases the production of certain chemicals in the immune system, such as cytokines.
• Smoking cigarettes: The chemicals in cigarettes cause oxidative stress to cells and also cause immune system dysfunction.
• Medication: This includes ACE inhibitors and beta-blockers often prescribed for heart problems.
• HIV: HIV is the virus that can lead to AIDS, which destroys the immune system.
• Bacterial infection: Specific bacteria, namely beta-hemolytic (type A) Streptococcus, can trigger psoriasis.
• Sunburn: While sun exposure is important for your health, excess exposure actually damages the skin and can promote more psoriasis flare-ups and other skin conditions like rosacea.

Treatment of Psoriasis

Psoriasis can be treated in various ways, including those listed below.

• Corticosteroid creams: These can be applied to the skin plaques to help reduce the immune response causing the symptoms.
• Medicated creams: Calcipotriol is a chemical that acts like vitamin D to promote normal skin cell development. This helps replace damaged keratinocytes.
• Salicylic acid cream: This is a potent anti-inflammatory that can be used topically for skin conditions.
• Oral immunosuppressant medications: Methotrexate and cyclosporine are most commonly used and are effective in treating psoriasis by decreasing the immune response.
• UV light therapy: There are cases where phototherapy by exposure to UV light is helpful, but it needs to be done only by a licensed practitioner because UV can also be harmful.
• Surgical removal of the tonsils: A tonsillectomy helps in patients who have strep A and psoriasis.

Conclusion

Tonsillitis that is caused by strep bacteria can worsen psoriasis in patients who have this skin condition. The stimulation of the immune system, specifically the T cells, antigens, and certain receptors due to the inflamed tonsils spread to the skin triggering a flare-up in psoriasis.

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Sources:

• Allen, H. B., Jadeja, S., Allawh, R. M., & Goyal, K. (2018). Psoriasis, chronic tonsillitis, and biofilms: Tonsillar pathologic findings supporting a microbial hypothesis. Ear, Nose & Throat Journal, 97(3), 79-82. https://pubmed.ncbi.nlm.nih.gov/29554401/
• Capon, F. (2017). The genetic basis of psoriasis. International journal of molecular sciences, 18(12), 2526. https://www.mdpi.com/1422-0067/18/12/2526
• Das, S. (2021). Psoriasis. https://www.msdmanuals.com/professional/dermatologic-disorders/psoriasis-and-scaling-diseases/psoriasis
• Kobayashi, S. (2011). Tonsil-related skin diseases and possible involvement of T cell co-stimulation in chronic focal infection. Recent Advances in Tonsils and Mucosal Barriers of the Upper Airways, 72, 83-85. https://pubmed.ncbi.nlm.nih.gov/21865697/
• Konstantinovsky, M. (2021). Psoriasis. https://www.webmd.com/skin-problems-and-treatments/psoriasis/psoriasis-sun-risks
• Mayo Clinic. Psoriasis. https://www.mayoclinic.org/diseases-conditions/tonsillitis/symptoms-causes/syc-20378479
• Naldi, L. (2016). Psoriasis and smoking: links and risks. Psoriasis (Auckland, NZ), 6, 65. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683129/
• Sigurdardottir, S. L., Thorleifsdottir, R. H., Valdimarsson, H., & Johnston, A. (2013). 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. Clinical & Experimental Immunology, 174(1), 139-151. https://academic.oup.com/cei/article/174/1/139/6421030?login=true
• Wardrop, P., Weller, R., Marais, J., & Kavanagh, G. (1998). Tonsillitis and chronic psoriasis. Clinical otolaryngology and allied sciences, 23(1), 67-68.https://pubmed.ncbi.nlm.nih.gov/9563669/

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