Neri S, Ierna D, D'Amico R A, Giarratano G, Leotta C
Institute of Internal and Emergency Medicine, University of Catania, S. Marta Hospital, Italy.
Hepatogastroenterology. 1999 Jul-Aug;46(28):2269-72.
BACKGROUND/AIMS: Numerous data have suggested that there may be a relationship between Helicobacter pylori (H. pylori) infection and extragastric diseases, including dermatological pathologies. We studied some cases of Hide's Prurigo Nodularis (NP), a very itchy skin disease of unknown origin, in order to asses whether there is a pathogenic correlation between PN and H. pylori infection.
Prurigo Nodularis had been diagnosed clinically and histologically in 42 outpatients (27 females and 15 males with mean age of 62 +/- 5 years). All patients were screened for H. pylori infection by esophagogastroduodenoscopy, histologic examination and specific immuno-enzymatic determination. Specific pharmacological treatment was administered to all patients with H. pylori infection.
H. pylori colonization was observed in 40/42 patients examined and 32/40 patients presented some immunologic alterations. After the pharmacological treatment, endoscopy and rapid urease test confirmed eradication of H. pylori in 39/40 cases; itching was greatly reduced in the latter and microscopic examination of repeated skin biopsies revealed an improved histologic picture in patients affected by PN associated with H. pylori infection.
The concomitant presence of skin disease, H. pylori infection and immune disorders infers that there may be a pathogenic connection between bacterial infection and the inflammatory alteration of PN. We believe that the pharmacologic treatment induced remission of the skin lesions by direct control of H. pylori chronic infection; in fact, H. pylori may have triggered or enhanced the vasculitis which, in turn, may have enhanced the clinical signs and inflammatory histologic component of PN.
背景/目的：大量数据表明，幽门螺杆菌（H. pylori）感染与包括皮肤病学病变在内的胃外疾病之间可能存在关联。我们研究了一些结节性痒疹（NP）病例，这是一种病因不明的非常瘙痒的皮肤病，以评估PN与H. pylori感染之间是否存在致病相关性。
42例门诊患者（27例女性和15例男性，平均年龄62±5岁）经临床和组织学诊断为结节性痒疹。所有患者均通过食管胃十二指肠镜检查、组织学检查和特异性免疫酶测定筛查H. pylori感染。对所有H. pylori感染患者进行了特异性药物治疗。
在42例接受检查的患者中有40例观察到H. pylori定植，40例患者中有32例出现了一些免疫改变。药物治疗后，内镜检查和快速尿素酶试验证实40例中有39例H. pylori被根除；后者的瘙痒大大减轻，对反复进行的皮肤活检的显微镜检查显示，与H. pylori感染相关的PN患者的组织学表现有所改善。
皮肤病、H. pylori感染和免疫紊乱同时存在表明，细菌感染与PN的炎症改变之间可能存在致病联系。我们认为，药物治疗通过直接控制H. pylori慢性感染诱导了皮肤病变的缓解；事实上，H. pylori可能引发或加剧了血管炎，而血管炎反过来又可能加剧了PN的临床症状和炎症组织学成分。
