Psoriasis is a chronic skin disease affecting around two percent of the population, with plaque psoriasis being the most common form. Guttate psoriasis, triggered often by Streptococcal infections, presents with small, red, scaly spots. A Cochrane Review aimed to update findings on antistreptococcal treatments for psoriasis, assessing interventions like tonsillectomy and antibiotics against no treatment or placebos. The review included five trials with 162 participants, but due to variations in study designs and participant characteristics, no meta-analysis was performed. Key outcomes such as time-to-resolution and long-term relapse rates were not measured in any trials, and the evidence quality was rated very low, indicating uncertainty in the results.

The trials explored systemic antibiotics (penicillin, azithromycin, rifampicin) and tonsillectomy for treating guttate and chronic plaque psoriasis. However, adverse events and the primary efficacy outcome were poorly reported or absent. The review highlighted the need for better-designed randomized controlled trials with adequate sample sizes and clear outcome measures, especially focusing on guttate psoriasis in young adults and children, who are most affected. Current guidelines do not recommend antistreptococcal treatments solely for psoriasis due to the lack of robust evidence supporting their efficacy and safety.

Reference: Dupire G, Droitcourt C, Hughes C, Le Cleach L. Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database Syst Rev. 2019;3(3):CD011571. doi: 10.1002/14651858.CD011571.pub2.