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Letters to JMG
Streptococcal infection distinguishes different types of psoriasis
  1. P Weisenseel1,
  2. B Laumbacher2,
  3. P Besgen1,
  4. D Ludolph-Hauser1,
  5. T Herzinger1,
  6. M Roecken1,
  7. R Wank2,
  8. J C Prinz1
  1. 1Department of Dermatology, University of Munich, Frauenlobstrasse 9-11, D-80337 Munich, Germany
  2. 2Institute for Immunology, University of Munich, Munich, Germany
  1. Correspondence to:
 Professor J C Prinz, Department of Dermatology, University of Munich, Frauenlobstrasse 9-11, D-80337 Munich, Germany;
 joerg.prinz{at}lrz.uni-muenchen.de

https://doi.org/10.1136/jmg.39.10.767

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    Key points

    • The link between streptococcal tonsillitis and first onset of psoriasis is well known.

    • Here we show that streptococcal infection is confined to a particular subtype of non-pustular psoriasis, which is defined by early onset (≤40 years), a positive family history, and the HLA molecules Cw6, B13, or B57.

    • This suggests distinct inherited immune response patterns to streptococcal antigens as a key to understanding the pathogenesis of psoriasis.

    Epidemiologically, the first manifestations of psoriasis are promoted by upper respiratory tract infections with Streptococcus pyogenes. Parallels to post-streptococcal disorders are obvious but still lack pathogenetic proof. Two types of non-pustular psoriasis, types I and II, can be distinguished according to age of onset, family history, and inheritance of certain HLA alleles. Here we show that only type I but not type II psoriasis is associated with streptococcal infection.

    Psoriasis vulgaris is a chronic inflammatory disease that affects 1.5-2% of people in western societies with severe and disabling inflammation of the skin and, occasionally, arthritis. It is currently regarded as an autoimmune-like disorder that is mediated by antigen specific activation of T cells in the skin of genetically predisposed subjects.1 A high incidence of streptococcal throat infections as the main trigger of first psoriasis exacerbation2,3 favours streptococcal antigens as causative agents that may induce cross reactive …

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