Helicobacter Pylori And Rosacea

[Guide]

H. pylori reaches the epithelium of the stomach image courtesy of Wikimedia Commons

H Pylori (Helicobacter Pylori) has been a controversy with rosacea for some time now. Some experts dismiss H Pylori’s role in rosacea and yet it remains a controversy since other rosacea experts continue to discuss H Pylori as a possible factor in rosacea. The reason why this is such a controversy is that treatment for H Pyori eradication improves rosacea is so many cases. For example, "This study was designed to examine the prevalence of gastric Helicobacter pylori (Hp) infection verified by 13C-UTB-test, CLO, Hp culture and serology (IgG) in patients with rosacea....The eradication of Hp leads to a dramatic improvement of symptoms of rosacea and reduction in related gastrointestinal symptoms, gastritis, hypergastrinemia and gastric acid secretion; and 3) Rosacea could be considered as one of the major extragastric symptoms of Hp infection probably mediated by Hp-related cytotoxins and cytokines." [20]

Gastrointestinal Rosacea
When treatment for rosacea improves by treating for gastrointestinal issues, i.e., eradicating H Pylori, it is called Gastrointestinal Rosacea [GR].

H Pylori
A report published by Dovepress in May 2017 says about H Pylori, "There is not sufficient evidence regarding how determinant the role of H. pylori is." [16] Another report on this subject published in the J Eur Acad Dermatol Venereol also in May 2017 "found weak associations between rosacea and Helicobacter pylori infection as well as an effect of Helicobacter pylori therapy on rosacea symptoms." [15]

A report in 2013 states, "There still proves to find a correlation of Hp infection with patients with rosacea but it can still be hypothesised as a cutaneous manifestation of an internal peptic ulcer disease." [11]

A report in January 2010 states that “Helicobacter pylori infection is implicated in the pathogenesis of extradigestive diseases such as acne rosacea…” A report by Mc Leer, Lacey and Powell in 2009 listed H Pylori as a possible factor in the pathophysiology in rosacea.

Another report in 2012 concluded:
"We concluded that H. pylori has a significant role in rosacea patients who had dyspeptic symptoms. The PPR type is more influenced by H. pylori and this is regarded as being because of certain virulent strains that increase the inflammatory response in gastric mucosa and also in cutaneous lesions." [9]

One report in 2003 suggests “some form of relationship between rosacea and H. pylori infection.” Two reports in 1996 suggested H Pylori’s role in rosacea with titles such as “Eradication of Helicobacter pylori as the only successful treatment in rosacea” and “Acne rosacea and Helicobacter pylori betrothed.” Rebora suggested in 1995 that the “role of H. pylori is more probable in erythrotic rosacea than in its papulopustular and granulomatous stages.” [1] These are just a few reports suggesting H Pylori as a factor in rosacea.

When you consider the fact that H Pylori was ‘officially’ discovered in 1986 by Drs Marshall and Warren in Australia who both won the Nobel Prize in 2005 for this discovery and changed the textbooks about how bacteria can survive in the human stomach and its relation to ulcers and other gastric problems and the fact that this gram negative bacteria is considered an infection that half the world’s population is carrying with most being totally asymptomatic it is a wonder that anyone can even connect H Pylori with rosacea at all. Yet the reports on H Pylori and rosacea keep coming out despite the fact that many reports negate H Pylori’s role in rosacea.

While there are many older reports suggesting H Pylori having some role in rosacea, newer reports dismiss this role. For instance, the late Dr. Kligman noted H Pylori’s controversial role in rosacea in his 2003 report. [2]

A report released in 2002 mentions ‘promising recent reports of beneficial H. pylori eradication’ in many cutaneous skin diseases except rosacea. [3]

A study published in May 2010 concluded, “There is no association between Helicobacter pylori infection and rosacea in current study.” [4]

Nevertheless, there are reports of H Pylori associated with rosacea indicating that eradicating H Pylori clears rosacea and discuss the possible cutaneous pathology of H Pylori to an autoimmune mechanism. A report in 2009 says, a “few case reports have documented associations between Helicobacter pylori infection and rosacea.” [5]

What is H Pylori and how does it relate to rosacea?
H Pylori is a gram negative bacteria that is considered an infection and harmful to humans.

According to one report, “more than 50% of the human population have long-term Helicobacter pylori infection.” [3] Wikipedia says that the diagnosis of H Pylori is done with different tests that are not failsafe and sometimes results in false positives. How anyone can know for sure that 50% of the human population is infected with H Pylori is quite suspect. The percentage of ‘infection’ of H Pylori, if indeed it is an infection, may be more or less than 50% .

According to Wikipedia, “Helicobacter pylori is a Gram-negative, microaerophilic bacterium that can inhabit various areas of the stomach, particularly the antrum. It causes a chronic low-level inflammation of the stomach lining and is strongly linked to the development of duodenal and gastric ulcers and stomach cancer. Over 80% of individuals infected with the bacterium are asymptomatic.”

So, if 80% of individuals are asymptomatic and they only discovered H Pylori in 1986 how do they know that H Pylori is a human pathogen? There is an amusing article, “So, What’s Your Problem with Gram-Negative Bacteria??,” that gets you thinking. Do you really think that medical science knows everything about H Pylori in a little over twenty years? Obviously sometimes H Pylori is a human pathogen and runs amuck causing us problems. But in 80% of individuals H Pylori is asymptomatic and obviously is in the stomach for some reason, possibly for some nefarious purpose such as an ulcer, but it is quite possible for some beneficial purpose as well. Could it be possible that a gram negative bacteria serves some useful purpose that as yet hasn’t been discovered? For instance, E. coli can help people and animals to digest food and help in providing vitamins but sometimes runs amuck causing some serious food poisoning. Could H Pylori have some beneficial yet undiscovered function for humans yet sometimes cause issues like E. coli does?

Could H Pylori be asymptomatic because it is helping us for some reason yet undiscovered, and sometimes for some yet undiscovered reason turns into a monster that causes problems like ulcers and rosacea?

SIBO has been associated with rosacea with gram negative bacteria associated with it such as H Pylori. One report says, “Gastric acid suppresses the growth of ingested bacteria, thereby limiting bacterial counts in the upper small intestine. Diminished acid production (hypochlorhydria) is a risk factor for SIBO, and can develop after colonization with Helicobacter pylori or as a consequence of aging. [6]

Gram Negative Folliculitis, a rosacea mimic, is an acne condition caused by Gram-negative organisms which usually develops in patients who have received systemic antibiotics for prolonged periods. This is quite odd when you consider that eradicating H Pylori, a gram negative bacterium, clears rosacea in some cases. This certainly raises some questions about using long term antibiotic treatment for rosacea, doesn’t it? More info on the long term antibiotic risks you should consider.

Since eradicating H Pylori involves the use of antibiotics it would be difficult to really know if the H Pylori is truly a factor in rosacea since antibiotics have been used for many years to successfully treat rosacea. If it were possible to eradicate H Pylori without using antibiotics and rosacea clears up, then, there would be some substantial evidence of H Pylori being a factor in rosacea

According to Wikipedia, “The standard first-line therapy is a one week “triple therapy” consisting of a proton pump inhibitors such as omeprazole, Lansoprazole and the antibiotics clarithromycin and amoxicillin. Variations of the triple therapy have been developed over the years…”  Proton pump inhibitors have been also listed as a systemic comorbidity in rosacea!

Since antibiotics are usually used in the eradication of H Pylori you can see why it would be difficult to know whether the clearing of rosacea is due to the eradication of the H Pylori or simply because antibiotics have been used successfully to treat rosacea for over fifty years.

Nevertheless, there are anecdotal reports that treatment for gastric problems has cleared rosacea.

For instance, one anecdotal report suggests that after treating a patient with gastritis and evidence of GERD that the rosacea cleared. [7] According to Wikipedia, “In 1999, a review of existing studies found that, on average, 40% of GERD patients also had H Pylori infection. The eradication of H. pylori can lead to an increase in acid secretion, leading to the question of whether H. pylori-infected GERD patients are any different than non-infected GERD patients. A double-blind study, reported in 2004, found no clinically significant difference between these two types of patients with regard to the subjective or objective measures of disease severity.“

A few other anecdotal reports have suggested digestive issues related to their rosacea. [8] There may be other anecdotal reports suggesting H Pylori eradication clears rosacea which I plan on adding to this page. If you have thoughts on this subject I suggest you post them here. 

Bonnie [10] reports that in Dr. Jonathan V. Wright's NUTRITION & HEALING Newsletter, February 2010, Getting to the root of Rosacea - in your stomach, Dr. Wright is reported to have said:

"It's sad that information about the very common connection between acne rosacea and low stomach acid has been lost. In 1948, an article about Rosacea in a major medical journal stated that "every Dermatologist knows" about this connection. In 2009, hardly any dermatolgists know about it. It's also important to note that 2/3 of individuals with Rosacea are actually infected with Helicobacter Pylori bacteria, a common cause of low stomach acid." This report cites no clinical papers on this subject. 

A report in 2006 concluded, "based upon these results, the relation between Helicobacter pylori and rosacea is supported, and infection should be investigated in these patients because an appreciable percentage of patients diagnosed with rosacea and Helicobacter pylori infection can benefit from eradication therapy, mainly in the papulopustular subtype." [12]

"H. pylori appears contribute to several inflammatory skin diseases. Rosacea is the most common skin disease potentially associated with H. pylori. In one study, H. pylori was present in 81% of rosacea patients who also had gastric complaints, and almost all of those patients harbored cagA+ strains. A similar Egyptian study found that both cagA and the s1m1 allele of vacA were more prevalent in papular rosacea patients. The papular rosacea patients responded better to eradication therapy than the erythematous rosacea patients. A limited study of ocular rosacea patients reports that the seven ocular rosacea patients responded better to H. pylori eradication therapy than did rosacea patients without ocular symptoms." [13]

"H. pylori has proven to be a more complex pathogen than early research indicated. Multiple surface carbohydrate structures, outer membrane proteins, and toxins interact to modify host cell signaling and the immune response.....Thirty years after its discovery, H. pylori remains an enigmatic pathogen with many secrets yet to be revealed." [13]

"The prevalence of Helicobacter pylori infection was also found to be higher in patients with rosacea than in controls [70]. However, other studies have failed to demonstrate a relationship between H. pylori and rosacea [14]. 

"This meta-analysis found weak associations between rosacea and Helicobacter pylori infection as well as an effect of Helicobacter pylori therapy on rosacea symptoms, albeit that these did not reach statistical significance. Whether a pathogenic link between the two conditions exists, or whether Helicobacter pylori infection represents a proxy for other factors remains unknown." [15]

"Although a possible pathogenetic link between H. pylori and rosacea is advocated by many authors, evidence is still interpreted differently by others." [17]

"Of 167 patients, 150 received H. pylori eradication therapy, demonstrating a 92% (138/150) cure rate.....The present study concluded that H. pylori eradication leads to improvement of rosacea." [18]

"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." [29]

"Some studies consider it as one of the recently identified human bacterial pathogens, and special attention is paid to the evidence suggesting that it is probably part of the composition of the human microbiome as a commensal (commensal from French to English is a table companion) or even a symbiont. The presented data discussing the presence or absence of the effect of H. pylori on human health suggest that there is an apparent ambiguity of the problem....On the other hand, the high prevalence of H. pylori in the population and its asymptomatic coexistence with humans in most of the world’s population indicates its persistence in the body as a representative of the microbiome and as a nonpathogenic microorganism." [22]

H Pylori Causes Low Gastric Acid 

It is has been known for some time that H Pylori reduces gastric acid. You should read this post about Low Gastric Acid and Rosacea. 

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End Notes

[1] Helicobacter pylori infection and autoimmune disease such as immune thrombocytopenic purpura
Ohta M.
Kansenshogaku Zasshi. 2010 Jan;84(1):1-8

The pathophysiology of rosacea.
Mc Aleer MA, Lacey N, Powell FC
G Ital Dermatol Venereol. 2009 Dec;144(6):663-71.

Helicobacter pylori and rosacea.
Zandi S, Shamsadini S, Zahedi MJ, Hyatbaksh M
East Mediterr Health J. 2003 Jan-Mar;9(1-2):167-71.

Eradication of Helicobacter pylori as the only successful treatment in rosacea
Kolibásová K, Tóthová I, Baumgartner J, Filo V.
Arch Dermatol. 1996 Nov;132(11):1393.

Acne rosacea and Helicobacter pylori betrothed
Wolf R.
Int J Dermatol. 1996 Apr;35(4):302-3

May Helicobacter pylori be important for dermatologists?
Rebora A, Drago F, Parodi A.
Dermatology. 1995;191(1):6-8

[2] A Personal Critique on the State of Knowledge of Rosacea
Albert M. Kligman, M.D., Ph.D.

[3] Helicobacter pylori infection in skin diseases: a critical appraisal.
Wedi B, Kapp A.
Am J Clin Dermatol. 2002;3(4):273-82.

[4] Risk factors associated with rosacea.
Abram K, Silm H, Maaroos HI, Oona M.
J Eur Acad Dermatol Venereol. 2010 May;24(5):565-71. Epub 2009 Oct 23.

[5] Helicobacter pylori infection and dermatologic diseases.
HERNANDO-HARDER AC, BOOKEN N, GOERDT S, SINGER MV, HARDER H.
Eur J Dermatol. 2009 Sep-Oct;19(5):431-44. Epub 2009 Jun 15.

[6] Small Intestinal Bacterial Overgrowth: A Comprehensive Review
Andrew C. Dukowicz, MD, Brian E. Lacy, PhD, MD, and Gary M. Levine, MD
Gastroenterology & Hepatology Volume 3, Issue 2 February 2007

[7]ice2meetyu’s report July 4, 2010

[8] Rosacea and digestive problems

[9] Role of Helicobacter pylori in common rosacea subtypes: A genotypic comparative study of Egyptian patients.
El-Khalawany M, Mahmoud A, Mosbeh AS, Abd Alsalam F, Ghonaim N, Abou-Bakr A.
J Dermatol. 2012 Oct 5. doi: 10.1111/j.1346-8138.2012.01675.x

[10] Bonnie's report at RSG

[11] Kathmandu Univ Med J (KUMJ). 2012 Oct-Dec;10(40):49-52.
The study of prevalence of helicobacter pylori in patients with acne rosacea.
Bhattarai S, Agrawal A, Rijal A, Majhi S, Pradhan B, Dhakal SS.
Department of Dermatology and Venereology, B.P.Koirala Institute of Health Sciences, Dharan, Nepal.

[12] REV ESP ENFERM DIG (Madrid) Vol. 98. N.° 7, pp. 501-509, 2006
Effect of Helicobacter pylori eradication therapy in rosacea patients
D. Boixeda de Miquel, M. Vázquez Romero, E. Vázquez Sequeiros, J. R. Foruny Olcina, P. Boixeda de Miquel1, A. López San Román, S. Alemán Villanueva and C. Martín de Argila de Prados

[13] World J Gastroenterol. 2014 Sep 28; 20(36): 12781–12808.
Published online 2014 Sep 28. doi:  10.3748/wjg.v20.i36.12781, PMCID: PMC4177463
Beyond the stomach: An updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment
Traci L Testerman and James Morris

[14] Int J Mol Sci. 2016 Sep; 17(9): 1562.
Published online 2016 Sep 15. doi:  10.3390/ijms17091562, PMCID: PMC5037831
Rosacea: Molecular Mechanisms and Management of a Chronic Cutaneous Inflammatory Condition
Yu Ri Woo, Ji Hong Lim, Dae Ho Cho, and Hyun Jeong Park, Chris Jackson, Academic Editor

[15] Acad Dermatol Venereol 2017 May 23. doi: 10.1111/jdv.14352
Rosacea is associated with Helicobacter pylori: a systematic review and meta-analysis. 
Jørgensen AR, Egeberg A, Gideonsson R, et al.

[16] Dovepress
Rosacea and Helicobacter pylori: links and risks
Elizabeth Lazaridou, Chrysovalantis Korfitis, Christina Kemanetzi, Elena Sotiriou, Zoe Apalla, Efstratios Vakirlis, Christina Fotiadou, Aimilios Lallas, Demetrios Ioannides

[17] Rosacea and Helicobacter pylori: links and risks.
Clin Cosmet Investig Dermatol. 2017;10:305-310
Lazaridou E, Korfitis C, Kemanetzi C, Sotiriou E, Apalla Z, Vakirlis E, Fotiadou C, Lallas A, Ioannides D

[18] J Dermatol. 2017 Sep;44(9):1033-1037. doi: 10.1111/1346-8138.13878. Epub 2017 Apr 28.
Effects of Helicobacter pylori treatment on rosacea: A single-arm clinical trial study.
Saleh P, Naghavi-Behzad M, Herizchi H, Mokhtari F, Mirza-Aghazadeh-Attari M, Piri R.

[19] United European Gastroenterol J. 2015 Feb;3(1):17-24. doi: 10.1177/2050640614559262.
Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea.
Gravina A1, Federico A1, Ruocco E2, Lo Schiavo A2, Masarone M3, Tuccillo C1, Peccerillo F2, Miranda A1, Romano L1, de Sio C1, de Sio I1, Persico M3, Ruocco V2, Riegler G1, Loguercio C1, Romano M1.

[20] J Physiol Pharmacol. 1999 Dec;50(5):777-86.
Helicobacter pylori and its eradication in rosacea.
Szlachcic A1, Sliwowski Z, Karczewska E, Bielański W, Pytko-Polonczyk J, Konturek SJ.

[21] A symptom of Helicobacter pylori infection which neutralizes and decreases secretion of gastric acid to aid its survival in the stomach. Wikipedia

Gastroenterology. 1997 Jul;113(1):15-24.
Helicobacter pylori infection and chronic gastric acid hyposecretion.
El-Omar EM1, Oien K, El-Nujumi A, Gillen D, Wirz A, Dahill S, Williams C, Ardill JE, McColl KE.

[22] World J Gastroenterol. 2021 Feb 21; 27(7): 545–560.
Helicobacter pylori: Commensal, symbiont or pathogen?
Vasiliy Ivanovich Reshetnyak, Alexandr Igorevich Burmistrov, and Igor Veniaminovich Maev