title: Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea.
abstract: OBJECTIVE
  Recent studies suggest a potential relationship between rosacea and Helicobacter pylori (H. pylori) infection or small intestinal bacterial overgrowth (SIBO), but there is no firm evidence of an association between rosacea and H. pylori infection or SIBO. We performed a prospective study to assess the prevalence of H. pylori infection and/or SIBO in patients with rosacea and evaluated the effect of H. pylori or SIBO eradication on rosacea.
  
  
  METHODS
  We enrolled 90 patients with rosacea from January 2012 to January 2013 and a control group consisting of 90 patients referred to us because of mapping of nevi during the same period. We used the (13)C Urea Breath Test and H. pylori stool antigen (HpSA) test to assess H. pylori infection and the glucose breath test to assess SIBO. Patients infected by H. pylori were treated with clarithromycin-containing sequential therapy. Patients positive for SIBO were treated with rifaximin.
  
  
  RESULTS
  We found that 44/90 (48.9%) patients with rosacea and 24/90 (26.7%) control subjects were infected with H. pylori (p = 0.003). Moreover, 9/90 (10%) patients with rosacea and 7/90 (7.8%) subjects in the control group had SIBO (p = 0.6). Within 10 weeks from the end of antibiotic therapy, the skin lesions of rosacea disappeared or decreased markedly in 35/36 (97.2%) patients after eradication of H. pylori and in 3/8 (37.5%) patients who did not eradicate the infection (p < 0.0001). Rosacea skin lesions decreased markedly in 6/7 (85.7%) after eradication of SIBO whereas of the two patients who did not eradicate SIBO, one (50%) showed an improvement in rosacea (p = 0.284).
  
  
  CONCLUSIONS
  Prevalence of H. pylori infection was significantly higher in patients with rosacea than control group, whereas SIBO prevalence was comparable between the two groups. Eradication of H. pylori infection led to a significant improvement of skin symptoms in rosacea patients.
authors: Dipartimento di Internistica Clinica e Sperimentale 'F Magrassi', Second University of Naples, Naples, Italy.
authors: Ag
authors: A
authors: Gravina
authors: Dipartimento di Internistica Clinica e Sperimentale 'F Magrassi', Second University of Naples, Naples, Italy.
authors: A
authors: A
authors: Federico
authors: Department of Dermatology, Second University of Naples, Naples, Italy.
authors: E
authors: E
authors: Ruocco
authors: Department of Dermatology, Second University of Naples, Naples, Italy.
authors: A
authors: A
authors: Lo Schiavo
authors: Internal Medicine and Hepathology Department, University of Salerno, Salerno, Italy.
authors: M
authors: M
authors: Masarone
authors: Dipartimento di Internistica Clinica e Sperimentale 'F Magrassi', Second University of Naples, Naples, Italy.
authors: C
authors: C
authors: Tuccillo
authors: Department of Dermatology, Second University of Naples, Naples, Italy.
authors: F
authors: F
authors: Peccerillo
authors: Dipartimento di Internistica Clinica e Sperimentale 'F Magrassi', Second University of Naples, Naples, Italy.
authors: A
authors: A
authors: Miranda
authors: Dipartimento di Internistica Clinica e Sperimentale 'F Magrassi', Second University of Naples, Naples, Italy.
authors: L
authors: L
authors: Romano
authors: Dipartimento di Internistica Clinica e Sperimentale 'F Magrassi', Second University of Naples, Naples, Italy.
authors: C
authors: C
authors: de Sio
authors: Dipartimento di Internistica Clinica e Sperimentale 'F Magrassi', Second University of Naples, Naples, Italy.
authors: I
authors: I
authors: de Sio
authors: Internal Medicine and Hepathology Department, University of Salerno, Salerno, Italy.
authors: M
authors: M
authors: Persico
authors: Department of Dermatology, Second University of Naples, Naples, Italy.
authors: V
authors: V
authors: Ruocco
authors: Dipartimento di Internistica Clinica e Sperimentale 'F Magrassi', Second University of Naples, Naples, Italy.
authors: G
authors: G
authors: Riegler
authors: Dipartimento di Internistica Clinica e Sperimentale 'F Magrassi', Second University of Naples, Naples, Italy.
authors: C
authors: C
authors: Loguercio
authors: Dipartimento di Internistica Clinica e Sperimentale 'F Magrassi', Second University of Naples, Naples, Italy.
authors: M
authors: M
authors: Romano
keywords: Helicobacter pylori; rosacea; small intestinal bacterial overgrowth
references: World J Gastroenterol. 2010 Jun 28;16(24):2978-90
references: 20572300
references: Rev Esp Enferm Dig. 2006 Jul;98(7):501-9
references: 17022699
references: Gastroenterology. 2012 Jul;143(1):55-61.e1; quize e13-4
references: 22484118
references: Med Sci Monit. 2005 Dec;11(12):CR576-9
references: 16319788
references: Aliment Pharmacol Ther. 2009 Mar 30;29 Suppl 1:1-49
references: 19344474
references: J Am Acad Dermatol. 1999 Mar;40(3):433-5
references: 10071314
references: Arch Dermatol. 1999 Jun;135(6):659-63
references: 10376693
references: J Cutan Med Surg. 2002 Mar-Apr;6(2):103-8
references: 11992181
references: Clin Gastroenterol Hepatol. 2008 Jul;6(7):759-64
references: 18456568
references: J Am Acad Dermatol. 2000 Mar;42(3):537-9
references: 10688740
references: J Gastroenterol Hepatol. 2008 Apr;23(4):652-9
references: 18005015
references: Pediatr Allergy Immunol. 2000 May;11(2):101-5
references: 10893012
references: Helicobacter. 2013 Oct;18(5):384-91
references: 23551920
references: Eur J Clin Invest. 2011 Apr;41(4):380-6
references: 21128930
references: Helicobacter. 2014 Sep;19 Suppl 1:1-5
references: 25167938
references: Indian J Dermatol Venereol Leprol. 2003 Mar-Apr;69(2):133-4
references: 17642857
references: Nat Clin Pract Gastroenterol Hepatol. 2006 Nov;3(11):622-32
references: 17068500
references: Dermatology. 1997;194(1):86
references: 9031803
references: Arch Dermatol. 1998 Apr;134(4):511
references: 9554311
references: Gut. 2010 Nov;59(11):1465-70
references: 20947881
references: Int J Dermatol. 2002 Nov;41(11):768-70
references: 12452999
references: J Am Acad Dermatol. 2003 Dec;49(6):1199
references: 14639425
references: J Eur Acad Dermatol Venereol. 2008 Jun;22(6):753-4
references: 18005018
references: Eur J Intern Med. 2013 Jan;24(1):16-9
references: 22877993
references: Antioxid Redox Signal. 2002 Aug;4(4):665-73
references: 12230879
references: J Oral Pathol Med. 2004 Mar;33(3):129-32
references: 15128053
references: Orphanet J Rare Dis. 2007 Jul 26;2:34
references: 17655751
references: J Eur Acad Dermatol Venereol. 2005 May;19(3):398-9
references: 15857486
references: Int J Dermatol. 2005 Dec;44(12):993-5
references: 16409261
references: J Eur Acad Dermatol Venereol. 2002 Jul;16(4):328-33
references: 12224687
references: Nature. 2000 Mar 23;404(6776):398-402
references: 10746728
references: Eur Rev Med Pharmacol Sci. 2013;17 Suppl 2:30-5
references: 24443065
references: J Am Acad Dermatol. 2002 Jan;46(1):141
references: 11756964
references: Aliment Pharmacol Ther. 1998 Dec;12(12):1257-62
references: 9882035
references: Clin Dermatol. 2010 Sep-Oct;28(5):478-82
references: 20797505
references: Am J Gastroenterol. 1998 Feb;93(2):220-2
references: 9468246
references: Clin Exp Dermatol. 2003 Jan;28(1):61-3
references: 12558633
references: Ann Dermatol Venereol. 2011 Nov;138 Suppl 3:S179-83
references: 22183096
references: J Dermatol. 1998 Jul;25(7):482-4
references: 9714985
references: J Am Acad Dermatol. 2002 Apr;46(4):584-7
references: 11907512
references: Helicobacter. 2007 Oct;12(5):567-71
references: 17760727
references: J Dermatol Sci. 2009 Aug;55(2):77-81
references: 19481425
references: Infect Immun. 2007 Aug;75(8):4030-9
references: 17562777
references: Acta Haematol. 2006;116(1):19-24
references: 16809885
references: P T. 2009 Jan;34(1):38-45
references: 19562004
references: Hepatogastroenterology. 1999 Jul-Aug;46(28):2269-72
references: 10521979
references: Skinmed. 2006 Jul-Aug;5(4):172-6
references: 16855407