Antistreptococcal interventions for guttate and chronic plaque psoriasis

Area of Science:

• Dermatology
• Immunology
• Infectious Diseases

Background:

• Psoriasis is a chronic inflammatory skin condition affecting 2% of the population.
• Plaque psoriasis presents as raised, red, scaly patches, while guttate psoriasis involves widespread small lesions.
• Streptococcal infections are suspected triggers for guttate psoriasis and flare-ups of chronic plaque psoriasis.

Purpose of the Study:

• To assess the effects of antistreptococcal interventions for guttate and chronic plaque psoriasis.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted.
• Searches included multiple databases (Cochrane Skin, CENTRAL, MEDLINE, Embase, LILACS) and trial registers up to January 2019.
• Included RCTs compared antistreptococcal interventions (tonsillectomy, systemic antibiotics) against placebo, no intervention, or each other.

Main Results:

• Five trials with 162 participants were included; meta-analysis was not performed due to heterogeneity.
• No trials measured time-to-resolution or long-term relapse risk.
• Evidence quality was rated as very low due to high risk of bias and imprecision, leading to uncertainty about efficacy and safety.

Conclusions:

• There is very low-quality evidence regarding the efficacy and safety of antistreptococcal interventions for psoriasis.
• Included trials had methodological limitations and a small number of unrepresentative participants.
• Further high-quality trials are needed, particularly for penicillin V or amoxicillin in guttate psoriasis.