Comment

Larger studies for longer treatment periods would be required to assess the place of this drug in psoriasis therapy.

We found two systematic reviews from the same group of investigators; one examined antistreptococcal interventions for both guttate and chronic plaque psoriasis (search date 2000, one RCT, 20 people)103 whilst the second examined other interventions for guttate psoriasis (search date 2000, one RCT, 21 people).104 We found no additional RCTs not considered by these investigators. No published report could be found to support or to challenge current commonly used methods of management of guttate psoriasis, which include tar, topical corticosteroids, vitamin D analogues and UVB phototherapy.

Although it is well known that guttate psoriasis may be precipitated by streptococcal infection, and antibiotics have frequently been advocated for patients with recurrent guttate psoriasis, the authors of the reviews concluded that there was 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.

Tonsillectomy has been advocated for patients with recurrent streptococcal sore throat associated with either recurrent guttate psoriasis or recalcitrant chronic plaque psoriasis; although an uncontrolled prospective study claimed clearance in five of six people with recurrent guttate psoriasis subjected to tonsillectomy,104 there is no firm evidence to date that such intervention is beneficial.

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