Palmoplantar pustulosis associated with gastric Helicobacter pylori infection

Palmoplantar Pustulosis: A Systematic Review of Risk Factors and Therapies

Palmoplantar pustulosis (PPP) is a chronic, relapsing, inflammatory disease that can occur alone or in association with arthritis. There is still controversy about whether it should be separated from psoriasis or classified as pustular psoriasis. Furthermore, drug-induced paradoxical PPP is a special variant of PPP that differs from classic PPP in several ways. Treatment of PPP is still challenging, and there are a number of treatment-resistant cases. This review summarizes the risk factors for the development of PPP and the currently available treatment modalities. Female sex, smokers or ex-smokers, obesity, thyroid dysfunction, and treatment with a tumor necrosis factor (TNF)-α inhibitor have been identified as risk factors for the disease's development, severity, and course. Topical treatments and phototherapy are effective for some patients and are used as a first-line or adjuvant treatment modality. Conventional treatments including retinoids and fumaric acid show good effects and can increase the efficacy of treatment with psoralen + ultraviolet light therapy (PUVA). Ciclosporin is fast acting, but relapse mostly occurs immediately after cessation. TNF-α inhibitors are efficient, and an even better response can be achieved with IL-17 and IL-23 blockers as well as apremilast. The effect of Janus kinase inhibitors seems to be promising according to case reports, but further investigations with larger cohorts are needed.

Relationship between Helicobacter pylori infection and psoriasis: a nationwide population-based longitudinal cohort study

BACKGROUND

In the current literature, studies assessing the role of Helicobacter pylori (HP) infection in psoriasis have reported conflicting data. Therefore, we investigated the association between HP infection and psoriasis using a nationwide population-based longitudinal cohort study.

METHODS

We identified 41,539 patients with HP infection and 83,078 matched controls between 2000 and 2013 from the Longitudinal Health Insurance Research Database of the National Health Insurance Research Database in Taiwan. Propensity score analysis was used to match age, sex, comorbidities, and medical visits at a ratio of 1:2. Multiple Cox regression analysis was used to estimate the adjusted hazard ratio of psoriasis. Furthermore, sensitivity tests and a stratified analysis were conducted.

RESULTS

The incidence rates of psoriasis did not differ significantly between the HP and control cohorts (4.58 vs 4.20 per 100,000 person-months, crude relative risk: 1.092, 95% confidence interval: 0.917-1.302). After multivariate adjustment, no significant difference in psoriasis risk was observed in patients with HP infection (adjusted hazard ratio: 1.081, 95% confidence interval: 0.907-1.288). Risk of psoriasis was significantly higher in men and the elderly, and in those with diabetes, hyperlipidemia, chronic obstructive pulmonary disease, or tuberculosis. Stratified analysis also confirmed that HP infection was not correlated with an increased risk of psoriasis based on follow-up duration, sex, and age.

CONCLUSION

This retrospective population-based longitudinal cohort study, conducted in Taiwan, found no association between HP infection and risk of psoriasis. Further research may be warranted.

Helicobacter pylori infection in psoriatic patients during biological therapy

BACKGROUND

Psoriasis is a relapsing inflammatory disease exacerbated by many triggers. Helicobacter pylori (H. pylori) is a Gram-negative bacterium causing the liberation of many cytokines and having a role in systemic inflammation. We assessed over a period of 12 months the presence of H. pylori in psoriatic patients undergoing biologic therapy and how PASI improved after its eradication.

METHODS

We performed an interventional, prospective, cohort, exploratory and mono-centric study in patients affected by moderate-severe psoriasis during biological therapy to assess the correlation between psoriasis (moderate to severe forms), and H. pylori infection. We also checked if the bacterial eradication could improve the severity of psoriasis throughout the variation of PASI over a 12-month period.

RESULTS

The prevalence of H. pylori was 35%. The average of PASI improved in H. pylori positive patients after the eradication (confidence interval: 33-44; P=0.023). H. pylori positive patients were more likely to have psoriatic arthropathy (P=0.049). Gastrointestinal symptoms (such as epigastric pain, postprandial heaviness, pyrosis) were found in only 31.3% of H. pylori positive patients.

CONCLUSIONS

Since the H. pylori infection is often asymptomatic, it can be useful to perform the 13C-Urea breath test, and to eradicate it before to start the psoriasis therapy in order to decrease the level of inflammation.

Relationship of Helicobacter pylori seroprevalence with the occurrence and severity of psoriasis

BACKGROUND

Psoriasis is a chronic inflammatory disease that affects the skin and joints and has a multifactorial etiology. Recently, it has been suggested that Helicobacter pylori infection may contribute as a trigger for the development of the disease.

OBJECTIVES

To determine the prevalence of H. pylori seropositivity in patients with psoriasis and to evaluate the relation between disease severity and H. pylori infection.

METHODS

H. pylori infection was assessed in psoriatic patients and controls by using H. pylori IgG quantitative enzyme immunoassay (ELISA test). The patients were classified according to the severity of the disease (PASI score).

RESULTS

One hundred and twenty six patients with psoriasis (73 females and 53 males); mean age 50.48 years; 65 patients (51.59%) had severe psoriasis, 40 (31.75%) moderate psoriasis and 21 (16.67%) mild psoriasis. Twenty one healthy volunteers included as a control group, mean age of 41.05 years, 13 females and 8 males. One hundred and eleven patients with psoriasis tested serologically, 80 (72.07%) were seropositive compared with 7 positive volunteers (33.33%; P=0.002). Forty-nine (75.38%) patients with severe psoriasis were positive, 25 (62.50%) with moderate psoriasis were positive and 6 (28.57%) with mild psoriasis were positive (P=0.045). Study limitations: none.

CONCLUSIONS

H. pylori infection influences the development of psoriasis and severity of the disease.

Helicobacter pylori infection in psoriasis: results of a clinical study and review of the literature

BACKGROUND

Data from the literature concerning the role of Helicobacter pylori (H. pylori) infection in psoriasis are still conflicting. This study was carried out to evaluate prevalence of H. pylori in patients with mild to severe psoriasis, correlation between H. pylori infection and severity of psoriasis, and effect of H. pylori eradication on the clinical course of psoriasis.

METHODS

Two hundred and ten patients with psoriasis and 150 healthy controls were screened for H. pylori through [(13) C] urea breath test at baseline (T0). All patients with psoriasis received standardized phototherapy treatment, and those infected by H. pylori were also treated with a 1-week triple therapy, then they were all re-evaluated four weeks later at the end of therapy (T5).

RESULTS

The prevalence of H. pylori was not higher in psoriasis than in the control group (20.27 vs. 22%; P > 0.05). Patients infected by H. pylori showed more severe psoriasis than uninfected patients (psoriasis area and severity index score 17.9 ± 7.1 vs. 13.7 ± 6.9; P = 0.04), and patients who received successful eradication of H. pylori infection showed a greater improvement of psoriasis than the others (psoriasis area and severity index score at T5 in patients infected by H. pylori was 8.36 ± 3.76, in uninfected patients was 10.85 ± 3.49; P = 0.006).

CONCLUSIONS

Patients with mild to severe psoriasis do not show a greater prevalence of H. pylori infection; however, H. pylori seems able to affect the clinical severity of psoriasis.

Helicobacter pylori and skin autoimmune diseases

Autoimmune skin diseases are characterized by dysregulation of the immune system resulting in a loss of tolerance to skin self-antigen(s). The prolonged interaction between the bacterium and host immune mechanisms makes Helicobacter pylori (H. pylori) a plausible infectious agent for triggering autoimmunity. Epidemiological and experimental data now point to a strong relation of H. pylori infection on the development of many extragastric diseases, including several allergic and autoimmune diseases. H. pylori antigens activate cross-reactive T cells and induce autoantibodies production. Microbial heat shock proteins (HSP) play an important role of in the pathogenesis of autoimmune diseases because of the high level of sequence homology with human HSP. Eradication of H. pylori infection has been shown to be effective in some patients with chronic autoimmune urticaria, psoriasis, alopecia areata and Schoenlein-Henoch purpura. There is conflicting and controversial data regarding the association of H. pylori infection with Behçet’s disease, scleroderma and autoimmune bullous diseases. No data are available evaluating the association of H. pylori infection with other skin autoimmune diseases, such as vitiligo, cutaneous lupus erythematosus and dermatomyositis. The epidemiological and experimental evidence for a possible role of H. pylori infection in skin autoimmune diseases are the subject of this review.

The role of Helicobacter pylori infection in skin diseases: facts and controversies

Helicobacter pylori is a Gram-negative bacterium that is considered a causative agent of peptic ulcer disease, gastric lymphoma, and gastric carcinoma. H pylori triggers an intense leucocyte infiltration of the gastric submucosa, an action that is mediated by proinflammatory cytokines. Because this pathogenetic mechanism is common to many other diseases, H pylori seroprevalence has also been investigated in other diseases. H pylori seropositivity is associated with various dermatologic disorders. Although the precise role of H pylori is unknown in these diseases, the organism can be eradicated, using simple and reliable drug regimens. This contribution highlights the dermatologic diseases associated with H pylori seropositivity.