May Helicobacter pylori be important for dermatologists?

Helicobacter pylori, a microaerophilic gram-negative bacterium, is the major cause of gastritis, plays a key role in the etiology of peptic ulcer and is a risk factor for gastric cancer. Although 50% of the population is affected, dermatologist seem to be unaware of the impact H. pylori may have on cutaneous pathology. Among skin diseases, H. pylori has been related so far only with chronic urticaria and rosacea. In rosacea, histology of the stomach mucosa revealed tht 84% of 31 patients were H. pylori positive. Twenty percent of them were serologically negative, but, overall, 100% of the 20 patients with both histology and serology were H. pylori positive with either test. The consistency between clinical success with metronidazole and abatement of H. pylori isolates and serology after treatment was an additional evidence suggesting an etiologic relationship between rosacea and H. pylori infection. Rosacea has often been linked with gastrointestinal disturbances. H. pylori, therefore, may link them to the well-known beneficial activity of metronidazole on rosacea lesions. The role of H. pylori is more probable in erythrotic rosacea than in its papulopustular and granulomatous stages. As in Bacillus subtilis intoxication, a flush-inducing toxin cannot be excluded. Despite the difficulty to find patients accepting bioptic gastroscopies, large case-control studies should be done before a causal relationship with urticaria and rosacea is firmly established.