Rosacea and Helicobacter pylori: interference of systemic antibiotic in the study of possible association

Association between rosacea and helicobacter pylori infection: A meta-analysis

BACKGROUND AND OBJECTIVES

The potential association between rosacea and a heightened prevalence of Helicobacter pylori (HP) infection has been previously suggested. However, existing studies offer inconsistent results. This systematic review and meta-analysis aimed to elucidate the relationship between rosacea and HP infection.

METHODS

We conducted comprehensive searches of PubMed, Embase, and Web of Science databases to identify relevant observational studies for our investigation. We utilized the random-effects model to aggregate the data to address the potential influence of heterogeneity among the studies on the outcome.

RESULTS

Our analysis incorporated twenty-five datasets from 23 case-control and cross-sectional studies, encompassing 51,054 rosacea patients and 4,709,074 controls without skin disease. The pooled results revealed a significantly higher prevalence of HP infection in individuals with rosacea compared to controls (odds ratio [OR]: 1.51, 95% confidence interval [CI]: 1.17-1.95, p<0.001; I2 = 79%). Subgroup analysis indicated an increased prevalence of HP infection in rosacea studies that utilized one (OR: 1.72, 95% CI: 1.11-2.66, p = 0.02; I2 = 76%) or more tests for HP infection (OR: 2.26, 95% CI: 1.29-3.98, p = 0.005; I2 = 56%). However, this association was not observed in population-based studies that determined HP infection based on prescription records for HP eradication drugs (OR: 0.90, 95% CI: 0.76-1.07, p = 0.024; I2 = 54%).

CONCLUSION

Rosacea may be significantly associated with a higher prevalence of HP infection. High-quality prospective studies with delicately controlled confounding factors are needed to determine if HP infection is a risk factor for rosacea.

The Role of Cosmetology in an Effective Treatment of Rosacea: A Narrative Review

Rosacea is a chronic inflammatory facial skin disease usually occurring in middle-aged patients. It manifests itself as an inflammatory condition with perivascular infiltrate, dilated blood vessels, lymphoedema, hyperplasia of sebaceous glands, and disorders of connective tissue structures brought on by fibrosis. Rosacea is characterized by multifactorial inflammatory mechanisms, and therefore it requires an interdisciplinary approach including adequate skin care, topical and/or systemic therapy, and physical modalities to successfully treat the various symptoms and disease subtypes. However, data regarding the possible role of cosmetologists in rosacea remains scanty and equivocal. The objectives of cosmetology therapy include restoration and regeneration, anti-inflammatory effects, the strengthening of blood vessels and regulation of their permeability, and the regulation of keratinization. Vascular abnormalities can be targeted with specific light and laser devices. Therefore, the present paper aims to review the latest advances and summarize different aspects concerning skin care in rosacea. Particular attention has been paid to the co-operation of cosmetologists with other specialists in order to bring about the interdisciplinary management of rosacea. It is also important to keep in mind that it is usually necessary to combine various methods of treatment, as this approach is more effective than monotherapy for attaining satisfactory cosmetic results in rosacea patients.

Rosacea, Germs, and Bowels: A Review on Gastrointestinal Comorbidities and Gut-Skin Axis of Rosacea

Rosacea is a chronic inflammatory disease with complicated pathophysiology that involves genetic and environmental elements and dysregulation of innate and adaptive immunity, neurovascular responses, microbiome colonization or infection, resulting in recurrent inflammation. Rosacea has been reported associated with various gastrointestinal diseases including inflammatory bowel disease, celiac disease, irritable bowel syndrome, gastroesophageal reflux disease, Helicobacter pylori (HP) infection, and small intestine bacterial overgrowth (SIBO). The link may involve common predisposing genetic, microbiota, and immunological factors, comprising the theory of the gut–skin axis. Although the evidence is still controversial, interestingly, medications for eradicating SIBO and HP provided an effective and prolonged therapeutic response in rosacea, and conventional therapy for which is usually disappointing because of frequent relapses. In this article, we review the current evidence and discuss probable mechanisms of the association between rosacea and gastrointestinal comorbidities.

The Skin and Gut Microbiome and Its Role in Common Dermatologic Conditions

Microorganisms inhabit various areas of the body, including the gut and skin, and are important in maintaining homeostasis. Changes to the normal microflora due to genetic or environmental factors can contribute to the development of various disease states. In this review, we will discuss the relationship between the gut and skin microbiome and various dermatological diseases including acne, psoriasis, rosacea, and atopic dermatitis. In addition, we will discuss the impact of treatment on the microbiome and the role of probiotics.

Evidence-based update on rosacea comorbidities and their common physiologic pathways

Rosacea is a common chronic inflammatory disease affecting the facial skin whose etiology and pathophysiology are the subject of much investigation. Risk factors include genetic and environmental elements that may predispose individuals to localized inflammation and abnormal neurovascular responses to stimuli. Recent studies have introduced an array of systemic rosacea comorbidities, such as inflammatory bowel disease and neurologic conditions, that can be challenging to synthesize. We critically review the current data behind reported rosacea comorbidities and identify and highlight underrecognized physiologic mediators shared among rosacea and associated comorbidities. This information may be helpful in addressing patient questions about potential systemic implications of rosacea and can serve as a candidate platform for future research to understand rosacea and improve treatments.

Rosacea and Helicobacter pylori: links and risks

Rosacea is a chronic skin disease characterized by facial erythema and telangiectasia. Despite the fact that many hypotheses have been proposed, its etiology remains unknown. In the present review, the possible link and clinical significance of Helicobacter pylori in the pathogenesis of rosacea are being sought. A PubMed and Google Scholar search was performed using the terms “rosacea”, “H.pylori”, “gastrointestinal disorders and H.pylori”, “microorganisms and rosacea”, “pathogenesis and treatment of rosacea”, and “risk factors of rosacea”, and selected publications were studied and referenced in text. Although a possible pathogenetic link between H. pylori and rosacea is advocated by many authors, evidence is still interpreted differently by others. We conclude that further studies are needed in order to fully elucidate the pathogenesis of rosacea.

Rosacea is associated with Helicobacter pylori: a systematic review and meta-analysis

BACKGROUND

Rosacea is a common skin disease characterized by facial erythema, telangiectasia, papules and pustules. Helicobacter pylori infection has been suggested to play a role in the etiopathogenesis of rosacea.

OBJECTIVE

To systematically review and meta-analyse the relationship between rosacea and infection with Helicobacter pylori.

METHODS

A literature search was performed using PubMed, EMBASE and Web of Science. Data extraction and analyses were performed on descriptive data. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effects models with DerSimonian-Laird methods were utilized to estimate pooled odds ratios (ORs), with 95% confidence intervals (95% CIs). Heterogeneity of results was assessed using I² statistics.

RESULTS

A total of 454 articles were identified and 42 full-text articles were chosen for further review. Fourteen studies were included in the quantitative meta-analysis, comprising a total of 928 rosacea patients and 1527 controls. The overall association between Helicobacter pylori infection and rosacea was non-significant (OR 1.68, 95% CI 1.00-2.84, P = 0.052), but analysis restricted to C-urea breath test showed a significant association (OR 3.12, 95% CI 1.92-5.07, P < 0.0001). Effect of eradication treatment on rosacea symptoms was assessed in seven studies, but without significant effect (RR 1.28, 95% CI 0.98-1.67, P = 0.069).

CONCLUSION

This meta-analysis found weak associations between rosacea and Helicobacter pylori infection as well as an effect of Helicobacter pylori therapy on rosacea symptoms, albeit that these did not reach statistical significance. Whether a pathogenic link between the two conditions exists, or whether Helicobacter pylori infection represents a proxy for other factors remains unknown.

Rosacea: part I. Introduction, categorization, histology, pathogenesis, and risk factors

Rosacea is a chronic inflammatory skin condition that affects approximately 16 million Americans. Four distinct subtypes of rosacea have been recognized, with transient and nontransient facial flushing, telangiectasia, and inflammatory papules and pustules being among the more commonly recognized features. Although the exact pathogenesis of rosacea is unknown, dysregulation of the innate immune system, overgrowth of commensal skin organisms, and aberrant neurovascular signaling may all have a role in promoting the clinical features of rosacea.

Potential role of microorganisms in the pathogenesis of rosacea

Rosacea is a skin condition of abnormal inflammation and vascular dysfunction. The active contribution of a microbial agent in the development or progression of rosacea continues to be debated. Research supports the presence of commensal Demodex folliculorum mites at increased density in the skin and associates Helicobacter pylori infection of the gut with rosacea. Fewer studies implicate Staphylococcus epidermidis, Chlamydophila pneumoniae, and the Demodex-associated bacteria Bacillus oleronius. No research, however, provides a mechanism by which colonization by a microorganism translates to manifestation of the condition. Prevailing and emerging principles in the biology of the microbiome and the pathophysiology of rosacea may help to reconcile these lingering questions. Here the microorganisms implicated in rosacea are reviewed and the reaction of the microbiome to inflammation and to changes in microenvironments and macroenvironments are discussed to explain potential roles for microorganisms in rosacea pathophysiology.

A comparative appraisal of the efficacy of different rosaceatreatment methods

There was a comparative appraisal of the efficacy of different papulopustular rosacea treatment methods: systemic administration of metronidazole, doxycycline hydrochloride and isotretinoin. The therapy efficacy was appraised based on the dynamics of the indices on the rosacea diagnostics scale in 98 patients suffering from papulopustular rosacea. Retinoid proved to be of maximum efficacy, which was confirmed by a more intense decrease in the indices on the rosacea diagnostics scale with a high share of remission patients. Conclusion: Isotretinoin has the maximum anti-inflammatory efficacy for treating patients with papulopustular rosacea.

The potential role of microorganisms in the development of rosacea

Rosacea is a chronic cutaneous disorder characterized by centrofacial persisting erythema, telangiectases, papules, pustules, edema, phymas and ocular involvement. Despite being one of the most common skin disorders, its pathogenesis remains unclear and controversial. Although the disease triggering factors are well recognized, the underlying causes of rosacea have not yet been identified. Several different postulates about its pathogenesis can be found in the medical literature. Abnormalities of the pilosebaceous unit, as well as genetic, vascular, inflammatory, environmental and microbial factors have been described. The microorganisms that have been associated include Helicobacter pylori, Demodex folliculorum, Staphylococcus epidermidis, and Chlamydia pneumonia; all the studies have been inconclusive. We review currently available scientific data on the potential pathogenetic role of microorganisms in the development of rosacea.

Risk factors associated with rosacea

BACKGROUND

Although rosacea is a common disease, the cause of disease is still a mystery -Helicobacter pylori infection, genetic predisposition, climatic factors, and detrimental habits are implicated as triggers of rosacea.

OBJECTIVE

The aim of current study is to evaluate several suspected risk factors coincidently.

METHODS

Patients with rosacea from a dermatology clinic and skin-healthy controls from an randomly selected employees' population enrolled the study. Skin status were evaluated by one and same dermatologist. Participants were queried for age, gender, sun-reactive skin type, and detrimental habits using a questionnaire; blood samples for detecting Helicobacter pylori serostatus were collected.

RESULTS

Totally 145 skin-healthy controls and 172 subjects either with flushing episodes or established rosacea included the study. In multivariate analysis, rosacea patients had significantly higher chance to have photosensitive skin types (OR 1.75; 95% CI 1.01-3.04; P < 0.05), positive family history to rosacea (OR 4.31; 95% CI 2.34-7.92; P < 0.0001) or previous smoking status (OR 2.01; 95% CI 1.07-3.80; P < 0.05) comparing with skin-healthy controls. There were no statistically significant differences either in gender, Helicobacter pylori serostatus, caffeine intake, alcohol consumption, occupational environment, or education level between rosacea patients and controls.

CONCLUSION

Rosacea is foremost associated with familial predisposition. There is no association between Helicobacter pylori infection and rosacea in current study.

Fatores associados à rosácea em amostras populacionais do Sul do Brasil: análise de estudos casos-controles

FUNDAMENTOS: A rosácea é dermatose que apresenta uma série de variáveis associadas a seu surgimento. A maioria dos estudos é proveniente dos Estados Unidos da América e de países europeus, sendo escasso o conhecimento produzido e publicado acerca da doença no Hemisfério Sul, particularmente no Brasil. OBJETIVOS: Descrever os principais fatores clínicos e histopatológicos associados à rosácea em amostras populacionais do sul do Brasil. MÉTODOS: Dois estudos casos-controles realizados em seqüência, com análise univariada e bivariada, utilizando-se p < 0,05 para significância estatística (teste do qui-quadrado e Mantel-Haenzel, quando realizadas estratificações). RESULTADOS: A rosácea é mais freqüente em mulheres e na faixa de 40-50 anos. Os pacientes com fototipos II e III configuram a quase-totalidade dos casos, as formas inflamatórias da rosácea são mais diagnosticadas do que a vascular, e há associação com a sorologia positiva para Helicobacter pylori e com a presença histopatológica do Demodex folliculorum (p < 0,05). As alterações emocionais e climáticas, a exposição solar e o uso de bebidas alcoólicas foram os principais fatores descritos como provocativos ou agravantes. CONCLUSÕES: Apresenta-se um panorama da rosácea obtido em amostra de população sulista do Brasil, com alguns dados semelhantes aos já descritos internacionalmente e outros particularizados, como a questão econômica e os fatores descritos como provocativos ou agravantes.

Rosácea granulomatosa: relato de caso - enfoque terapêutico

Os autores descrevem um caso de rosácea granulomatosa em um homem de 39 anos de idade, tratado com a associação de limeciclina oral e metronidazol gel tópico. A rosácea granulomatosa é uma variante da rosácea clássica, rara, caracterizada pela presença de pápulas vermelho-acastanhadas ou pequenos nódulos com base eritematosa e infiltrada, surgindo geralmente na superfície lateral da face e no pescoço. O exame histopatológico evidencia granulomas perifoliculares e perivasculares. A evolução é crônica, e o tratamento inclui antibióticos orais, como a tetraciclina e seus derivados, e medicações tópicas, como metronidazol, ácido retinóico, entre outras.