Many dermatologists may appreciate the role that tonsillar infections with Streptococcus pyogenes play in exacerbating or triggering their patients' psoriasis. Especially relevant is the role of tonsillar streptococcal colonization in guttate psoriasis and in some cases in plaque psoriasis.1, 2 Perianal streptococcal infection has been observed in guttate psoriasis.