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Alavinejad P, Nayebi M, Parsi A, Abdelsameea E, Ahmed MH, Hormati A, Viet Hang D, Pezeshgi Modarres M, Cheraghian B, Baghaee S, Farbod Ara T, Trung Tran Q, Shanker Behl N, Hashemi SJ, Alboraie M, Salman S, Nha L, V. Patai Á, Hajiani E, Abravesh AA. Levofloxacin+Tetracycline Quadruple Regimen for Eradication of Helicobacter pylori: A Multicenter Multinational Randomized Controlled Trial. Middle East J Dig Dis 2023; 15:12-18. [PMID: 37547163 PMCID: PMC10404071 DOI: 10.34172/mejdd.2023.314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/20/2022] [Indexed: 08/08/2023] Open
Abstract
Background: The ideal combination regimen for Helicobacter pylori (HP) eradication has not yet been determined and the success rate of HP eradication has been extensively reduced worldwide due to increasing antibiotic resistance. So this multinational multi-center randomized controlled trial was designed to evaluate the efficacy of tetracycline +levofloxacin for HP eradication. Methods: During a 6-month period, all of the cases with HP infection in eight referral tertiary centers of three countries were included and randomly allocated to receive either tetracycline + levofloxacin or clarithromycin plus amoxicillin quadruple regimen for two weeks. For all of the participants, pantoprazole was continued for 4 more weeks and after one to two weeks of off-therapy, they underwent urea breath test C13 to prove eradication. Results: Overall 788 patients were included (358 male (45.4%), average age 44.2 years). They were diagnosed as having non-ulcer dyspepsia (516 cases, 65.5%), peptic ulcer disease (PUD) (234 cases, 29.69%), and intestinal metaplasia (38 cases, 4.8%). Racially 63.1% were Caucasian, 14.5% Arab, 15.6% African, and 6.1% Asian. The participants were randomly allocated to groups A and B to receive either tetracycline + levofloxacin or clarithromycin. Among groups A and B in intention to treat (ITT) and per protocol (PP) analysis, 75.2% & 82.1% (285 cases) and 67.5% & 70.1% (276 cases) of participants achieved eradication, respectively (P = 0.0001). The complete compliance rate in groups A and B were 84.4% and 83.6%, respectively. During the study, 33.5% of the participants in group A (127 cases) reported side effects while the complication rate among group B was 27.9% (114 cases, P = 0.041). The most common complaints among groups A and B were nausea and vomiting (12.6% & 9.3%) and abdominal pain (4.48% & 2.68%), respectively. The rate of severe complications that caused discontinuation of medication in groups A and B were 2.1% and 1.46%, respectively (P = 679). In subgroup analysis, the eradication rates of tetracycline+levofloxacin among patients with non-ulcer dyspepsia, PUD, and intestinal metaplasia were 79.4%, 88.1%, and 73.9%, respectively. These figures in group B (clarithromycin base) were 71.3%, 67.6%, and 61.5% respectively (P = 0.0001, 0.0001, and 0.043). Conclusion: Overall, the combination of tetracycline+levofloxacin is more efficient for HP eradication in comparison with clarithromycin+amoxicillin despite more complication rate. In areas with a high rate of resistance to clarithromycin, this therapeutic regimen could be an ideal choice for HP eradication, especially among those who were diagnosed with PUD.
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Affiliation(s)
- Pezhman Alavinejad
- Alimentary Tract Research Center, Imam Khomeini Hospital Clinical Research Development Unit, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- World Endoscopy Organization Emerging Star Group, WEO, Munich, Germany
| | - Morteza Nayebi
- Shahid Rajaie Cardiovascular, Medical & Research Center, Tehran, Iran
| | - Abazar Parsi
- Alimentary Tract Research Center, Imam Khomeini Hospital Clinical Research Development Unit, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Eman Abdelsameea
- Assistant Professor of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Egypt
| | - Mohammed Hussien Ahmed
- Lecturer Hepatology Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Cairo, Egypt
| | - Ahmad Hormati
- Gastrointestinal and Liver Diseases Research Center, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Dao Viet Hang
- Lecturer, Internal Medicine Faculty - Hanoi Medical University (HMU), Vietnam
| | - Mehdi Pezeshgi Modarres
- Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Bahman Cheraghian
- Alimentary Tract Research Center, Imam Khomeini Hospital Clinical Research Development Unit, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Siamak Baghaee
- Alimentary Tract Research Center, Imam Khomeini Hospital Clinical Research Development Unit, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Ahvaz Branch, Islamic Azad University, Ahvaz, Iran
| | - Tahmine Farbod Ara
- Alimentary Tract Research Center, Imam Khomeini Hospital Clinical Research Development Unit, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Quang Trung Tran
- World Endoscopy Organization Emerging Star Group, WEO, Munich, Germany
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Vietnam
- Department of Internal Medicine A, Greifswald University of Medicine, Greifswald, Germany
| | - Nitin Shanker Behl
- Institute of Gastro and Liver Diseases, Fortis Hospital, Ludhiana, India
| | - Seyed Jalal Hashemi
- Alimentary Tract Research Center, Imam Khomeini Hospital Clinical Research Development Unit, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammed Alboraie
- World Endoscopy Organization Emerging Star Group, WEO, Munich, Germany
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Saif Salman
- Hashemite University, Faculty of Medicine, Alzarqa, Jordan
| | - Le Nha
- Gastroenterology Division, Internal Medicine and Hematology Department, Semmelweis University, Budapest, Hungary
| | - Árpád V. Patai
- Gastroenterology Division, Internal Medicine and Hematology Department, Semmelweis University, Budapest, Hungary
- Interdisciplinary Gastroenterology Working Group, Semmelweis University, Budapest, Hungary
| | - Eskandar Hajiani
- Alimentary Tract Research Center, Imam Khomeini Hospital Clinical Research Development Unit, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Akbar Abravesh
- Alimentary Tract Research Center, Imam Khomeini Hospital Clinical Research Development Unit, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Wu MC, Ma KSK, Chen HH, Huang JY, Wei JCC. Relationship between Helicobacter pylori infection and psoriasis: a nationwide population-based longitudinal cohort study. Medicine (Baltimore) 2020; 99:e20632. [PMID: 32541501 PMCID: PMC7302646 DOI: 10.1097/md.0000000000020632] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
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.
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Affiliation(s)
- Meng-Che Wu
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Gastroenterology, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kevin Sheng-Kai Ma
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Life science, National Taiwan University, Taipei, Taiwan
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Huang-Hsi Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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Bardazzi F, Magnano M, Fiorini G, Vaira D, Odorici G, Bertusi G, Patrizi A. Helicobacter pylori infection in psoriatic patients during biological therapy. Ital J Dermatol Venerol 2020; 156:570-574. [PMID: 32041937 DOI: 10.23736/s2784-8671.19.06410-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Federico Bardazzi
- Division of Dermatology, Department of Clinical, Experimental and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Michela Magnano
- Division of Dermatology, Department of Clinical, Experimental and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Giulia Fiorini
- Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - Dino Vaira
- Department of Surgical and Medical Sciences, University of Bologna, Bologna, Italy
| | - Giulia Odorici
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy -
| | - Gabriele Bertusi
- Division of Dermatology, Department of Clinical, Experimental and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Division of Dermatology, Department of Clinical, Experimental and Specialty Medicine, University of Bologna, Bologna, Italy
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Yu M, Zhang R, Ni P, Chen S, Duan G. Helicobacter pylori Infection and Psoriasis: A Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2019; 55:medicina55100645. [PMID: 31561576 PMCID: PMC6843633 DOI: 10.3390/medicina55100645] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/14/2019] [Accepted: 09/24/2019] [Indexed: 02/08/2023]
Abstract
Background and Objectives: To perform a systematic review and meta-analysis with the aim of determining the relationship between H. pylori infection and psoriasis. Methods: Pubmed, Embase, China National Knowledge Infrastructure (CNKI), and Web of Science were searched for articles published up to July, 2019. Review Manager 5.3 and Stata 12.0 were used for statistical analyses. Results: The initial database search resulted in 204 articles. Through exclusion and screening, 11 studies involving a total of 1741 participants were finally included in this meta-analysis. The odds ratio (OR) of H. pylori infection rate in the psoriasis group was significantly higher than that in the control group (OR = 1.19, 95% CI 1.15–2.52, P = 0.008). Subgroup analysis showed that no significant difference was detected between the Asia group and the Europe group. As for the methods of H. pylori detection, a statistically significant increase of H. pylori infection in the IgG ELISA test group was detected, compared with the urea breath test group. In addition, analysis based on the severity of psoriasis showed a statistically significant increase of H. pylori infection in moderate and severe psoriasis patients (OR = 2.27; 95% CI: 1.42–3.63, I2 = 27%), but not in the mild psoriasis patients (OR = 1.10; 95% CI: 0.79–1.54, I2 = 0%). Conclusion: H. pylori infection is associated with psoriasis, and psoriasis patients with H. pylori infection have higher Psoriasis Area and Severity Index (PASI) scores. The findings are of considerable significance for the clinical practices.
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Affiliation(s)
- Mingyang Yu
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China.
| | - Rongguang Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China.
| | - Peng Ni
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China.
| | - Shuaiyin Chen
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China.
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China.
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Inate immunity in rosacea. Langerhans cells, plasmacytoid dentritic cells, Toll-like receptors and inducible oxide nitric synthase (iNOS) expression in skin specimens: case-control study. Arch Dermatol Res 2018; 310:139-146. [DOI: 10.1007/s00403-018-1806-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/30/2017] [Accepted: 01/04/2018] [Indexed: 01/14/2023]
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Weiss E, Katta R. Diet and rosacea: the role of dietary change in the management of rosacea. Dermatol Pract Concept 2017; 7:31-37. [PMID: 29214107 PMCID: PMC5718124 DOI: 10.5826/dpc.0704a08] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/21/2017] [Indexed: 12/19/2022] Open
Abstract
Dietary change may play a role in the therapy of rosacea. Certain foods and beverages may act as "triggers" for rosacea exacerbations. These may be divided into heat-related, alcohol-related, capsaicin-related, and cinnamaldehyde-related. One potential pathogenic mechanism may be via the activation of transient receptor potential cation channels, which result in neurogenic vasodilatation. Further research is needed on the role of the gut skin connection in rosacea. Epidemiologic studies suggest that patients with rosacea have a higher prevalence of gastrointestinal disease, and one study reported improvement in rosacea following successful treatment of small intestinal bacterial overgrowth. While further research is required in this area, patients may be advised on measures to support a healthy gut microbiome, including the consumption of a fiber-rich (prebiotic) diet.
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Affiliation(s)
- Emma Weiss
- Baylor College of Medicine, Houston, TX, USA
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7
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Saleh P, Naghavi-Behzad M, Herizchi H, Mokhtari F, Mirza-Aghazadeh-Attari M, Piri R. Effects of Helicobacter pylori treatment on rosacea: A single-arm clinical trial study. J Dermatol 2017; 44:1033-1037. [PMID: 28452093 DOI: 10.1111/1346-8138.13878] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 03/11/2017] [Indexed: 01/11/2023]
Abstract
Rosacea is a chronic dermatological disease. Helicobacter pylori has been discussed as one of its causative factors. In this clinical trial study, we attempted to evaluate the effect of H. pylori standard eradication protocol on the rosacea clinical course. In this single-arm clinical trial, patients ascertained to have H. pylori infection based on serological studies were assessed to examine existence of rosacea. Patients with concurrent rosacea and H. pylori infection were included in the study and underwent standard H. pylori eradication therapy. Rosacea was evaluated using the Duluth rosacea grading score at the beginning, 2 months later and at the end of the trial (day 180). Of 872 patients positive for H. pylori, 167 patients (19.15%) manifested the clinical features of rosacea. The patients with concurrent rosacea were younger (P < 0.001) and with a female sex predominance (P = 0.03) when compared with rosacea-free patients. Of 167 patients, 150 received H. pylori eradication therapy, demonstrating a 92% (138/150) cure rate. The rosacea Duluth score grading on day 0, 60 and 180 among 138 patients significantly decreased in most of the criteria except for telangiectasias (P = 0.712), phymatous changes (P = 0.535) and the existence of peripheral involvement (P = 0.431). The present study concluded that H. pylori eradication leads to improvement of rosacea.
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Affiliation(s)
- Parviz Saleh
- Chronic Kidney Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hamdieh Herizchi
- Department of Dermatology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Mokhtari
- Department of Dermatology, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Reza Piri
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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8
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Lewinska A, Wnuk M. Helicobacter pylori-induced premature senescence of extragastric cells may contribute to chronic skin diseases. Biogerontology 2017; 18:293-299. [PMID: 28074309 PMCID: PMC5350214 DOI: 10.1007/s10522-017-9676-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/02/2017] [Indexed: 02/06/2023]
Abstract
Helicobacter pylori, one of the most frequently observed bacterium in the human intestinal flora, has been widely studied since Marshall and Warren documented a link between the presence of H. pylori in the gastrointestinal tract and gastritis and gastric ulcers. Interestingly, H. pylori has also been found in several other epithelial tissues, including the eyes, ears, nose and skin that may have direct or indirect effects on host physiology and may contribute to extragastric diseases, e.g. chronic skin diseases. More recently, it has been shown that H. pylori cytotoxin CagA expression induces cellular senescence of human gastric nonpolarized epithelial cells that may lead to gastrointestinal disorders and systemic inflammation. Here, we hypothesize that also chronic skin diseases may be promoted by stress-induced premature senescence (SIPS) of skin cells, namely fibroblasts and keratinocytes, stimulated with H. pylori cytotoxins. Future studies involving cell culture models and clinical specimens are needed to verify the involvement of H. pylori in SIPS-based chronic skin diseases.
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Affiliation(s)
- Anna Lewinska
- Department of Genetics, University of Rzeszow, Werynia 502, 36-100, Kolbuszowa, Poland.
| | - Maciej Wnuk
- Department of Genetics, University of Rzeszow, Werynia 502, 36-100, Kolbuszowa, Poland.
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9
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Woo YR, Lim JH, Cho DH, Park HJ. Rosacea: Molecular Mechanisms and Management of a Chronic Cutaneous Inflammatory Condition. Int J Mol Sci 2016; 17:ijms17091562. [PMID: 27649161 PMCID: PMC5037831 DOI: 10.3390/ijms17091562] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/23/2016] [Accepted: 09/07/2016] [Indexed: 01/21/2023] Open
Abstract
Rosacea is a chronic cutaneous inflammatory disease that affects the facial skin. Clinically, rosacea can be categorized into papulopustular, erythematotelangiectatic, ocular, and phymatous rosacea. However, the phenotypic presentations of rosacea are more heterogeneous. Although the pathophysiology of rosacea remains to be elucidated, immunologic alterations and neurovascular dysregulation are thought to have important roles in initiating and strengthening the clinical manifestations of rosacea. In this article, we present the possible molecular mechanisms of rosacea based on recent laboratory and clinical studies. We describe the genetic predisposition for rosacea along with its associated diseases, triggering factors, and suggested management options in detail based on the underlying molecular biology. Understanding the molecular pathomechanisms of rosacea will likely aid toward better comprehending its complex pathogenesis.
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Affiliation(s)
- Yu Ri Woo
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.
| | - Ji Hong Lim
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.
| | - Dae Ho Cho
- Department of Life Science, Sookmyung Women's University, Seoul 04310, Korea.
| | - Hyun Jeong Park
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea.
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10
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Kim J, Ahn JW, Ha S, Kwon SH, Lee O, Oh C. Clinical assessment of rosacea severity: oriental score vs. quantitative assessment method with imaging and biomedical tools. Skin Res Technol 2016; 23:186-193. [PMID: 27514310 DOI: 10.1111/srt.12318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Rosacea is a common chronic inflammatory disorder affecting facial skin. Currently, no accurate and objective method is available for assessing the severity of rosacea. Most studies use the National Rosacea Society Standard (NRSS) grading method, which lacks objectivity and yields varying results. METHODS Eighteen patients with rosacea were included. Clinical severity was assessed on the basis of the NRSS grade, Investigators' Global Assessment, Patients' Global Assessment, and Dermatology Quality of Life Index. A skin color analysis system was used to measure the facial area showing erythema, and biophysical parameters of facial skin (transepidermal water loss and skin surface hydration) were examined. To find statistical significant in classification severity of the rosacea, statistical analysis was performed with all parameters. RESULTS A significant correlation (P < 0.05) was found between the NRSS grade, facial area showing erythema, and biophysical parameters. The latter two factors differed significantly among patients with rosacea of different levels of severity (mild, moderate, severe; P < 0.05). CONCLUSION Color imaging systems can be useful and reliable for evaluating the severity of rosacea, in addition to biophysical parameter assessment. The combination of these two analytical methods enabled objective and quantitative evaluation of the severity of rosacea.
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Affiliation(s)
- J Kim
- Research Institute for Skin Imaging, Korea University Medical School, Seoul, Korea
| | - J W Ahn
- Research Institute for Skin Imaging, Korea University Medical School, Seoul, Korea
| | - S Ha
- Department of Nursing, School of Health, Chungbuk Health and Science University, Chungbuk, Korea
| | - S H Kwon
- Department of Dermatology, Korea University Medical School, Seoul, Korea
| | - O Lee
- Department of Medical IT Engineering, College of Medical Sciences, Soonchunhyang University, Chungnam, Korea
| | - C Oh
- Research Institute for Skin Imaging, Korea University Medical School, Seoul, Korea.,Department of Dermatology, Korea University Medical School, Seoul, Korea
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11
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Cardwell LA, Alinia H, Moradi Tuchayi S, Feldman SR. New developments in the treatment of rosacea - role of once-daily ivermectin cream. Clin Cosmet Investig Dermatol 2016; 9:71-7. [PMID: 27051311 PMCID: PMC4807898 DOI: 10.2147/ccid.s98091] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Rosacea is a chronic dermatological disorder with a variety of clinical manifestations localized largely to the central face. The unclear etiology of rosacea fosters therapeutic difficulty; however, subtle clinical improvement with pharmacologic treatments of various drug categories suggests a multifactorial etiology of the disease. Factors that may contribute to disease pathogenesis include immune abnormality, vascular abnormality, neurogenic dysregulation, presence of cutaneous microorganisms, UV damage, and skin barrier dysfunction. The role of ivermectin in the treatment of rosacea may be as an anti-inflammatory and anti-parasitic agent targeting Demodex mites. In comparing topical ivermectin and metronidazole, ivermectin was more effective; this treatment modality boasted more improved quality of life, reduced lesion counts, and more favorable participant and physician assessment of disease severity. Patients who received ivermectin 1% cream had an acceptable safety profile. Ivermectin is efficacious in decreasing inflammatory lesion counts and erythema.
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Affiliation(s)
- Leah A Cardwell
- Department of Dermatology, Center for Dermatology Research, Winston-Salem, NC, USA
| | - Hossein Alinia
- Department of Dermatology, Center for Dermatology Research, Winston-Salem, NC, USA
| | - Sara Moradi Tuchayi
- Department of Dermatology, Center for Dermatology Research, Winston-Salem, NC, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Winston-Salem, NC, USA; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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12
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Immunohistochemistry in the diagnosis of cutaneous bacterial infections. Am J Dermatopathol 2015; 37:179-93; quiz 194-6. [PMID: 25699977 DOI: 10.1097/dad.0000000000000227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The identification of pathogens is of vital importance for the adequate treatment of infections. During the past 2 decades, the approach to histopathologic diagnosis has been dramatically transformed by immunohistochemistry (IHC) specifically in the diagnosis and classification of tumors and more recently in the diagnosis of infectious diseases in tissue samples. The main goals of this article were to: (1) identify by IHC the cutaneous structures where bacterial pathogens are expressed in the course of infection, (2) identify the specific cells in which bacterial pathogens are expressed in positive cases, and (3) describe the pattern of distribution of the bacterial antigens within these cells (nuclear, cytoplasmatic, or membranous). This article is an up-to-date overview of the potential uses and limitations of IHC in the histopathologic diagnosis of cutaneous bacterial infections. In conclusion, IHC is especially useful in the identification of microorganisms that are present in low numbers, stain poorly, are fastidious to grow, culture is not possible, or exhibit an atypical morphology.
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Rosacea: part I. Introduction, categorization, histology, pathogenesis, and risk factors. J Am Acad Dermatol 2015; 72:749-58; quiz 759-60. [PMID: 25890455 DOI: 10.1016/j.jaad.2014.08.028] [Citation(s) in RCA: 210] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/01/2014] [Accepted: 08/18/2014] [Indexed: 11/22/2022]
Abstract
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.
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Campanati A, Ganzetti G, Martina E, Giannoni M, Gesuita R, Bendia E, Giuliodori K, Sandroni L, Offidani A. Helicobacter pylori infection in psoriasis: results of a clinical study and review of the literature. Int J Dermatol 2015; 54:e109-14. [PMID: 25808243 DOI: 10.1111/ijd.12798] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- Anna Campanati
- Dermatological Unit, Department of Clinical and Moleciular Sciences, Polytechnic Marche University, Ancona, Italy
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Association between Helicobacter pylori Infection and Chronic Urticaria: A Meta-Analysis. Gastroenterol Res Pract 2015; 2015:486974. [PMID: 25861258 PMCID: PMC4378606 DOI: 10.1155/2015/486974] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/27/2015] [Indexed: 02/08/2023] Open
Abstract
Background. Some studies have shown the possible involvement of Helicobacter pylori (H. pylori) infection in chronic urticaria, but the relationship remains controversial. The aim of this meta-analysis was to quantitatively assess the association between H. pylori infection and chronic urticaria. Methods. Observational studies comparing the prevalence of H. pylori infection in patients with chronic urticaria and control subjects were identified through a systematic search in MEDLINE and EMBASE up to July 2014. H. pylori infection was confirmed by serological or nonserological tests. For subgroup analyses, studies were separated by region, publication year, and H. pylori detection method to screen the potential factors resulting in heterogeneity. Results. 16 studies involving 965 CU cases and 1235 controls were included. Overall, the prevalence of H. pylori infection was higher in urticarial patients than in controls (OR = 1.66; 95% CI: 1.12–2.45; P = 0.01). This result persisted in subanalysis of nine high-quality studies (OR = 1.36; 95% CI: 1.03–1.80; P = 0.03). Subgroup analysis showed that detection method of H. pylori is also a potential influential factor for the overall results. Conclusions. Our present meta-analysis suggests that H. pylori infection is significantly, though weakly, associated with an increased risk of chronic urticaria.
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Gravina AG, Federico A, Ruocco E, Lo Schiavo A, Masarone M, Tuccillo C, Peccerillo F, Miranda A, Romano L, de Sio C, de Sio I, Persico M, Ruocco V, Riegler G, Loguercio C, Romano M. Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea. United European Gastroenterol J 2015; 3:17-24. [PMID: 25653855 PMCID: PMC4315682 DOI: 10.1177/2050640614559262] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 10/15/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS 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.
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Affiliation(s)
- AG Gravina
- Dipartimento di Internistica Clinica e Sperimentale ‘F Magrassi', Second University of Naples, Naples, Italy
| | - A Federico
- Dipartimento di Internistica Clinica e Sperimentale ‘F Magrassi', Second University of Naples, Naples, Italy
| | - E Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
| | - A Lo Schiavo
- Department of Dermatology, Second University of Naples, Naples, Italy
| | - M Masarone
- Internal Medicine and Hepathology Department, University of Salerno, Salerno, Italy
| | - C Tuccillo
- Dipartimento di Internistica Clinica e Sperimentale ‘F Magrassi', Second University of Naples, Naples, Italy
| | - F Peccerillo
- Department of Dermatology, Second University of Naples, Naples, Italy
| | - A Miranda
- Dipartimento di Internistica Clinica e Sperimentale ‘F Magrassi', Second University of Naples, Naples, Italy
| | - L Romano
- Dipartimento di Internistica Clinica e Sperimentale ‘F Magrassi', Second University of Naples, Naples, Italy
| | - C de Sio
- Dipartimento di Internistica Clinica e Sperimentale ‘F Magrassi', Second University of Naples, Naples, Italy
| | - I de Sio
- Dipartimento di Internistica Clinica e Sperimentale ‘F Magrassi', Second University of Naples, Naples, Italy
| | - M Persico
- Internal Medicine and Hepathology Department, University of Salerno, Salerno, Italy
| | - V Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
| | - G Riegler
- Dipartimento di Internistica Clinica e Sperimentale ‘F Magrassi', Second University of Naples, Naples, Italy
| | - C Loguercio
- Dipartimento di Internistica Clinica e Sperimentale ‘F Magrassi', Second University of Naples, Naples, Italy
| | - M Romano
- Dipartimento di Internistica Clinica e Sperimentale ‘F Magrassi', Second University of Naples, Naples, Italy
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The Effect of Radioactive Iodine Treatment on 14C Urea Breath Test Results in Patients with Hyperthyroidism. Clin Nucl Med 2014; 39:1022-6. [DOI: 10.1097/rlu.0000000000000519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Bruscky DMV, Bruscky DMV, da Rocha LAR, Costa AJF. Recurrence of chronic urticaria caused by reinfection by Helicobacter pylori. REVISTA PAULISTA DE PEDIATRIA 2014; 31:272-5. [PMID: 23828067 DOI: 10.1590/s0103-05822013000200021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 09/14/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe a case of chronic urticaria in a female adolescent associated with Helicobacter pylori infection, confirmed in two different occasions, with improvement of urticaria after the antibacterial treatment. CASE DESCRIPTION A 13-year-old female patient sought medical care with chronic urticaria and epigastric pain unresponsive to medical treatment. Laboratorial tests for further investigation were normal except for the upper gastrointestinal endoscopy with biopsy showing moderate chronic active gastritis associated with Helicobacter pylori. After specific and appropriate treatment, the patient had remission of the symptoms. A new upper gastrointestinal endoscopy to control the treatment after nine months was normal. After five years, the patient returned with recurrence of urticaria and epigastric pain. She was taking antihistamines, without any improvement. It was again submitted to screening protocol for chronic urticaria with normal results. She was submitted to upper gastrointestinal endoscopy, which showed positive urease test. The patient started a new treatment for Helicobacter pylori with disappearance of chronic urticaria and epigastric pain within seven days. COMMENTS The reported case suggests a causal relationship between the positive diagnosis of Helicobacter pylori and the occurrence of chronic urticaria, showing the remission of symptoms after the institution of effective therapy for this agent. Chronic urticaria is a disease of complex etiology, and although controversial, there is growing evidence of Helicobacter pylori involvement with extraintestinal diseases, including chronic urticaria.
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Affiliation(s)
| | - Dayanne Melo V Bruscky
- Centro de Pesquisas em Alergia e Imunologia, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil
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Abstract
The discovery of Helicobacter pylori infection in the stomach could be considered as one of the most important events of modern gastroenterology. Understanding of the natural history of many disorders of the upper gastrointestinal tract, including chronic gastritis, peptic ulcer disease, gastric cancer and MALT lymphoma, was altered by this discovery. Interestingly, epidemiological studies have also revealed a correlation between H. pylori infection and some diseases localized outside the stomach, especially those characterized by persistent and low-grade systemic inflammation. Of note, H. pylori has an important role in iron deficiency anaemia, idiopathic thrombocytopenic purpura and vitamin B12 deficiency. Moreover, the association of this bacterial pathogen with many other diseases, including hepatobiliary, pancreatic, cardiovascular and neurodegenerative disorders is currently under investigation. In this Review, we summarize the results of the most important studies performed to date surrounding the association of H. pylori infection with extragastric diseases, as well as the strength of the evidence. We also provide information concerning bacterial-host interactions and the mechanisms implicated in the pathogenesis of each of these extragastric diseases.
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The Clinical Correlations of Helicobacter pylori Virulence Factors and Chronic Spontaneous Urticaria. Gastroenterol Res Pract 2013; 2013:436727. [PMID: 23956739 PMCID: PMC3730156 DOI: 10.1155/2013/436727] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 06/27/2013] [Indexed: 01/10/2023] Open
Abstract
Background and Study Aims. The association between Helicobacter pylori (H. pylori) and chronic spontaneous urticaria (CSU) remains controversial. This study explored the role of H. pylori in CSU among different virulent genotypes patients. Patients and Methods. Patients infected by H. pylori were sorted into two groups as group A (with CSU) and group B (without CSU). The tissue materials were taken via endoscopy for polymerase chain reaction study to determine virulence factors. After H. pylori eradication therapy, the eradication rate and response of urticaria were evaluated by using C(13)-UBT and a three-point scale (complete remission, partial remission, or no improvement). Results. The results were comparable between patients of groups A and B in terms of H. pylori infection rates and eradication rate. Longitudinal follow-up of 23.5 months showed complete remission of urticaria in 63.6% but no improvement in 36.4% of the patients after H. pylori eradication. H. pylori infected patients with different virulence factors such as cytotoxin-associated gene A, vacuolating cytotoxin gene A signal region and middle region have similar remission rates for CSU. Conclusions. Current study suggests that H. pylori may play a role in the development and disease course of CSU but may be irrelevant to different virulent genotypes.
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Grzybowski A, Sak J. Edmund Biernacki (1866-1911): Discoverer of the erythrocyte sedimentation rate. On the 100th anniversary of his death. Clin Dermatol 2013; 29:697-703. [PMID: 23293796 DOI: 10.1016/j.clindermatol.2011.08.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In contemporary medicine, the erythrocyte sedimentation rate (ESR) is used to assess severity in patients with such diseases as erysipelas, psoriasis, eosinophilic fasciitis, dermatomyositis, and Behçet's disease. We remember the scientific achievements of a Polish physician, the discoverer of the erythrocyte sedimentation rate (ESR), Edmund Faustyn Biernacki (1866-1911), on the 100th anniversary of his death. The practical application of ESR in clinical diagnostics in 1897 by Biernacki was little known for many years, because it was often neglected owing to the work of Robert Fåhraeusand Alf Westergren from 1921. In addition, it is also frequently omitted that before Westergren's and Fåhraeus's reports were published, ESR was also noticed by Ludwig Hirschfeld in 1917.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, Poznań City Hospital, ul. Szwajcarska 3, 61-285 Poznań, Poland; Medical Faculty, University of Warmia and Mazury, Olsztyn, Poland.
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Magen E, Mishal J. Possible benefit from treatment of Helicobacter pylori in antihistamine-resistant chronic urticaria. Clin Exp Dermatol 2012; 38:7-12. [PMID: 23083221 DOI: 10.1111/j.1365-2230.2012.04467.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Some patients with chronic spontaneous urticaria (CU) are resistant to conventional doses of antihistamine (AH) medications. Some research groups have reported an association between CU and Helicobacter pylori infection. AIM To determine whether H. pylori eradication can reverse AH resistance in CU. METHODS We retrospectively reviewed cases of patients with CU, and recorded their Urticaria Activity Score (UAS) and results of a (13)C-urea breath test ((13)C-UBT) for H. pylori infection. Patients without improvement in CU despite a full 8 weeks of AH treatment at four times the initial dose comprised the resistant CU group, while the patients who did respond comprised the responsive CU group. Patients with resistant CU and a positive (13)C-UBT (n = 46) were offered a 14-day treatment with amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily and omeprazole 20 mg twice daily. The effect of H. pylori eradication on CU was evaluated by the UAS, measured at baseline and at 8, 16, and 28 weeks after triple therapy. RESULTS Of the 46 patients with resistant CU, 29 (63%) had a positive (13)C-UBT result. Treatment eradicated H. pylori in 18 of the 29 patients (subgroup A), and 11 patients refused the triple therapy (subgroup B). The remaining 17 patients had a negative (13)C-UBT result, (subgroup C). In subgroup A, baseline UAS reduced from 5.29 ± 0.94 to 3.62 ± 0.96 (P = 0.03) at week 8; to 1.43 ± 0.41 (P < 0.001) at week 16, and to 1.17 ± 0.32 (P = 0.04) at week 28. Five of the patients (27.8%) in this group were completely free of symptoms at week 28, whereas none of the untreated patients achieved complete remission. CONCLUSION Some patients with resistant CU might benefit from H. pylori eradication.
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Affiliation(s)
- E Magen
- Leumit Health Services, Barzilai medical Center, Ashkelon, Israel.
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Abstract
A 23-year-old Chinese man presented with a 3-year history of a pruritic eruption. On examination, pink urticarial papules associated with hyperpigmented reticulated patches were noted on his neck, back, and upper chest. Histopathology revealed vacuolar interface dermatitis and numerous gram-negative rods within a dilated hair follicle. The organisms were reactive with anti-Helicobacter pylori immunohistochemisty. The histologic findings and clinical presentation support the diagnosis of prurigo pigmentosa. Additional testing demonstrated a positive urease breath test and serum H. pylori IgG antibodies. The patient was referred to gastroenterology and treated with appropriate antibiotics. After treatment, esophagogastroduodenoscopy revealed chronic gastritis without evidence of H. pylori infection and his skin showed reticulated hyperpigmented patches without evidence of active inflammatory papules. Although previous reports have associated prurigo pigmentosa to H. Pylori gastritis, this is the first report of H. pylori organisms identified in a skin biopsy of prurigo pigmentosa.
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Moya DA, Crissinger KD. Helicobacter pylori persistence in children: distinguishing inadequate treatment, resistant organisms, and reinfection. Curr Gastroenterol Rep 2012; 14:236-242. [PMID: 22350943 DOI: 10.1007/s11894-012-0251-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Helicobacter pylori is a worldwide infection that causes chronic gastritis, duodenal ulcers, and malignancy. Transmission of Helicobacter pylori within a family appears to be the predominant mode of contamination. Recurrence of the infection is frequently seen following treatment. Lack of eradication due to either inadequate treatment or resistant bacteria vs. reinfection have been explanations for detection of H. pylori following treatment. In this article we will discuss the concepts of inadequate treatment vs. resistant infection and reinfection as causes of persistent H. pylori infection.
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Affiliation(s)
- Diana A Moya
- Pediatric Gastroenterology Fellow at the Digestive Disease and Nutrition Center, Division of Pediatric Gastroenterology, Women and Children's Hospital of Buffalo, State University of New York at Buffalo, Buffalo, NY 14222, USA.
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Di Lorenzo G, Leto-Barone MS, La Piana S, Seidita A, Rini GB. Chronic spontaneous urticaria: an autoimmune disease? A revision of the literature. Clin Exp Med 2012; 13:159-64. [PMID: 22584681 DOI: 10.1007/s10238-012-0188-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
Abstract
The cause of chronic spontaneous urticaria has been an enigma for decades, but the recognition of functional autoantibodies in some patients with the spontaneous chronic urticaria has opened up a new concept of autoimmune urticaria. Clinical and laboratory features are in keeping with an autoimmune aetiology for many patients with otherwise inexplicable disease, but there is still debate about the importance of functional autoantibodies in the disease pathogenesis, how to test them and the clinical implications for treatment and prognosis. This review will look at the evidence for there being an autoimmune subset of urticaria, the strengths and weaknesses of the available tests in current use.
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Affiliation(s)
- Gabriele Di Lorenzo
- Dipartimento di Medicina Interna e Specialistica (DIMIS), Università degli Studi di Palermo, Via del Vespro, 141, 90127, Palermo, Italy.
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Clinical, cellular, and molecular aspects in the pathophysiology of rosacea. J Investig Dermatol Symp Proc 2012; 15:2-11. [PMID: 22076321 DOI: 10.1038/jidsymp.2011.7] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Rosacea is a chronic inflammatory skin disease of unknown etiology. Although described centuries ago, the pathophysiology of this disease is still poorly understood. Epidemiological studies indicate a genetic component, but a rosacea gene has not been identified yet. Four subtypes and several variants of rosacea have been described. It is still unclear whether these subtypes represent a "developmental march" of different stages or are merely part of a syndrome that develops independently but overlaps clinically. Clinical and histopathological characteristics of rosacea make it a fascinating "human disease model" for learning about the connection between the cutaneous vascular, nervous, and immune systems. Innate immune mechanisms and dysregulation of the neurovascular system are involved in rosacea initiation and perpetuation, although the complex network of primary induction and secondary reaction of neuroimmune communication is still unclear. Later, rosacea may result in fibrotic facial changes, suggesting a strong connection between chronic inflammatory processes and skin fibrosis development. This review highlights recent molecular (gene array) and cellular findings and aims to integrate the different body defense mechanisms into a modern concept of rosacea pathophysiology.
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