Tonsil and Pustulosis Palmaris Et Plantaris: Mainly in Respect of Complement

Abstract

Since the tonsil is one of the immunological Organs, a concept whereby the relation between the tonsil and pustulosis palmaris et plantaris (hereafter abbreviated ppp) can be explained by a specific immological mechanism, has been favoured. It must be pointed out, however, that there have been a considerable number of clinical findings which are irreconcilable with this concept. The present authors have therefore observed the relationship between the tonsil and PPP, from the point of view of non-specific in viva factors, such as complements and endotoxins. This theory of the authors was motivated by the clinical fact that the serum complement titres of some patients with PPP were changed by performing the tonsillar provocation test, and that in such cases their skin rashes were aggravated after provocation. Thereafter, the distribution of the complemental components in the tonsillar tissue was examined with the immunofluorescence technique and it was found that they were localized mainly in the epithelium of the tonsillar crypt. In other words, the region where the complement system in the tonsillar tissue is active is the crypt. It was further found that the lacunar debris in the tonsillar crypt possesses a Strong complement-activating activity. In particular, it was discovered that the action is stronger in bacteria and endotoxins within the lacunar debris. In recent years, the activation of complements associated with the surface layer of the skin has been emphatically considered to be the mechanism causing the onset of aseptic pustules in patients with PPP. To be more specific, Arthuss phenomenon is caused on the surface layer of the skin by the stratum corneum and anti-stratum corneum antibody, and in this case the neutrophil chemotactic factor which originated from the activated complement system is believed to participate in the formation of pustules. It has been postulated that if some substance with a strong complement activating action existing in the tonsillar crypt were to enter from the epithelium into the systemic circulation system, it might have some influence on Arthuss phenomenon occurring on the surface layer of the skin via the complement system. Thus, if we emphasize the association of a non-specific factor, then the focus in focal sections is not necessarily and exclusively the tonsil–all other pathological changes, including those caused by sinusitis, otitis media or furuncle, and which can activate the complement system, may be the focus of these infections.