Antistreptococcal interventions for guttate and chronic plaque psoriasis

 

Abstract

Background

Guttate psoriasis is a distinctive acute form of psoriasis which characteristically occurs in children and young adults. It is closely associated with preceding streptococcal sore throat or tonsillitis. Some authorities have claimed that ordinary (chronic plaque) psoriasis may also be made worse by infection at distant sites. Although many dermatologists have recommended using antibiotics for guttate psoriasis in particular, it is not clear whether they influence the course of either form of psoriasis. Some dermatologists have also recommended tonsillectomy for psoriasis in patients with recurrent streptococcal sore throat.

Objectives

To assess the evidence for effectiveness of antistreptococcal interventions including antibiotics and tonsillectomy in the management of acute guttate and chronic plaque psoriasis.

Search methods

We searched the Cochrane Clinical Trials Register (Cochrane Library, Issue 3, 1999), Medline (1966- September 1999), Embase (1988-September 1999), the Salford Database of Psoriasis Trials (to November 1999) and the European Dermato-Epidemiology Network (EDEN) Psoriasis Trials Database (to November 1999) for terms [STREPTOCOCC* or ANTIBIOTIC* or TONSIL*] and PSORIASIS using the Cochrane Skin Group search strategy.

Selection criteria

Randomised trials of one or more antistreptococcal interventions in patients with guttate or chronic plaque psoriasis.

Data collection and analysis

Two reviewers independently examined each retrieved trial for eligibility and quality.

Main results

The one eligible trial we identified compared the use of two oral antibiotic schedules in 20 psoriasis patients, predominantly of guttate type, who had evidence of beta-haemolytic streptococcal colonisation. Either rifampicin or placebo was added to the end of a standard course of antistreptococcal antibiotic (phenoxymethylpenicillin or erythromycin). No patient in either arm of the study improved during the observation period.

No randomised trials of tonsillectomy for psoriasis were identified.

Authors' conclusions

Although it is well known that guttate psoriasis may be precipitated by streptococcal infection, there is no firm evidence to support the use of antibiotics either in the management of established guttate psoriasis or in preventing the development of guttate psoriasis following streptococcal sore throat.

Although both antibiotics and tonsillectomy have frequently been advocated for patients with recurrent guttate psoriasis or chronic plaque psoriasis, there is to date no good evidence that either intervention is beneficial.

 

Plain language summary

Antibiotics or tonsillectomy for people with psoriasis.

Psoriasis, a disease which produces scaly pink patches on the skin, often gets worse after a bacterial throat infection or tonsillitis. When someone with psoriasis has a throat infection, antibiotics are sometimes used in an attempt to prevent this from happening. For people with psoriasis and repeated throat infections tonsillectomy is sometimes recommended. The review found no evidence from trials that either antibiotics or tonsillectomy are helpful for people with psoriasis.

 

摘要

背景

對於滴狀和慢性板塊型乾癬的抗鏈球菌治療

滴狀乾癬是一種好發於小孩和年輕人的急性乾癬.它與發病前有鏈球菌咽喉炎或扁桃腺炎有密切的關係.有些研究機構甚至指出一般型 (慢性板塊型) 乾癬在有遠處感染時會惡化.雖然許多皮膚科醫師有特別建議在滴狀乾癬時使用抗生素,目前仍不清楚抗生素使用是否會影響乾癬的病程.有些皮膚科醫師也建議在有反覆鏈球菌咽喉炎的乾癬患者採取扁桃腺切除.

目標

評估包括抗生素使用和扁桃腺切除對於急性滴狀乾癬和慢性板塊性乾癬的治療成效

搜尋策略

我們在以下的資料庫,以Cochrane Skin Group的搜索策略,合併[鏈球菌或抗生素或扁桃腺]和[乾癬]為關鍵字搜尋:Cochrane Clinical Trials Register (Cochrane Library, 第3期, 1999), Medline (1966September 1999), Embase (1988September 1999), the Salford Database of Psoriasis Trials (to November 1999), 和European DermatoEpidemiology Network (EDEN) Psoriasis Trials Database (to November 1999)

選擇標準

在滴狀乾癬和慢性板塊性乾癬的病人身上使用一種或多種抗鏈球菌治療的隨機試驗

資料收集與分析

兩位獨立的審查人員分別檢視每個試驗的資格和品質

主要結論

我們找到一個合格的臨床試驗,在20位以滴狀乾癬為主，同時有貝他型溶血性鏈球菌增生的病人身上,比較兩種口服抗生素療程.在標準的抗鏈球菌療程 (phenoxymethylpenicillin或是 erythromycin) 中加入rifampicin或是安慰劑.兩組病人在觀察期都沒有顯著的進步.扁桃腺切除術在乾癬病人則沒有隨機試驗被找到。

作者結論

雖然大家都知道鏈球菌感染有可能會引起滴狀乾癬，目前仍無良好的証據証明抗生素的使用對於已經是滴狀乾癬的病人，或是對於在鏈球菌咽喉炎之後預防滴狀乾癬的發生會有幫助。雖然抗生素和扁桃腺切除術都常常在反覆性滴狀乾癬或慢性板塊型乾癬病人身上施行，目前仍無証據認為兩者是有益的。

翻譯人

本摘要由馬偕醫院黃政傑翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

無良好的証據証明抗生素或扁桃腺切除術對於乾癬的病人有幫助。乾癬是一種在皮膚上產生粉紅色脫屑性斑塊的疾病，通常會在細菌性咽喉炎或扁桃腺炎之後惡化。當乾癬病人得到咽喉炎的時候，有時候會使用抗生素避免此種情況發生。對於反覆咽喉炎的乾癬病人而言，有時候會建議扁桃腺切除術。這份回顧發現並沒有証據顯示抗生素或扁桃腺切除術對於乾癬的病人有幫助。