title: Etiopathogenesis of rosacea: a prospective study with a three-year follow-up.
abstract: BACKGROUND
  The aim of this study was to investigate the role of Demodex folliculorum (DF), Helicobacter pylori (HP), and small intestine bacterial overgrowth (SIBO) in the development of rosacea.
  
  
  METHODS
  A case-control study including 60 patients with rosacea and 40 healthy controls was performed. All the patients underwent standardized skin surface biopsy to investigate DF, urea breath test for HP and lactulose breath test and glucose breath test for SIBO. Etiological therapy was started in the following order: acaricidal treatment, antibiotics for SIBO and HP. These exams were repeated after 3 years. Statistical analysis was performed.
  
  
  RESULTS
  As regards the 88 patients who completed the entire follow-up, DF positivity was found in 47.7% of the patients, SIBO in 25.0%, and HP in 21.6%. SIBO significantly prevailed in papulopustular rosacea, while HP in erythrosis. At the 6-month follow up, the 61% of patients were in remission. After 3 years, 18% of patients dropped out, while the remaining patients repeated all the investigations. The majority of patients were still in remission and negative for HP while only 5 were positive for DF and 4 for SIBO.
  
  
  CONCLUSIONS
  SIBO was the most relevant factor in papulopustular rosacea. Its treatment was crucial in improvement and in maintaining the clinical remission.
authors.affiliation: Section of Dermatology, Department of Health Sciences, University of Genoa, San Martino-IST Hospital and Institute for Research and Care, Genoa, Italy - a.agnoletti@virgilio.it.
authors.forename: Arianna F
authors.initials: AF
authors.lastname: Agnoletti
authors.affiliation: Section of Dermatology, Department of Health Sciences, University of Genoa, San Martino-IST Hospital and Institute for Research and Care, Genoa, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: DE Col
authors.affiliation: Section of Dermatology, Department of Health Sciences, University of Genoa, San Martino-IST Hospital and Institute for Research and Care, Genoa, Italy.
authors.forename: Aurora
authors.initials: A
authors.lastname: Parodi
authors.affiliation: Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Schiavetti
authors.affiliation: Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Savarino
authors.affiliation: Section of Dermatology, Department of Health Sciences, University of Genoa, San Martino-IST Hospital and Institute for Research and Care, Genoa, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Rebora
authors.affiliation: Section of Dermatology, Department of Health Sciences, University of Genoa, San Martino-IST Hospital and Institute for Research and Care, Genoa, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Paolino
authors.affiliation: Section of Dermatology, Department of Health Sciences, University of Genoa, San Martino-IST Hospital and Institute for Research and Care, Genoa, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cozzani
authors.affiliation: Section of Dermatology, Department of Health Sciences, University of Genoa, San Martino-IST Hospital and Institute for Research and Care, Genoa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Drago
mesh_terms: D056810:Acaricides / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D001765:Blind Loop Syndrome / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D001944:Breath Tests; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D008924:Mite Infestations / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D012393:Rosacea / Q000209:etiology* / Q000382:microbiology / Q000469:parasitology; D055815:Young Adult
chemical_list: D056810:Acaricides; D000900:Anti-Bacterial Agents