Patients With Psoriasis Demonstrate Higher Rates of Helicobacter Pylori Infection Versus Controls

Patients with psoriasis have significantly higher rates of Helicobacter pylori (H. pylori) infection versus controls without psoriatic disease, according to a study published in Skin Research and Technology.¹

However, researchers reported no observed correlation between presence of H. pylori and overall disease severity.

Image Credit: © Milan Lipowski - stock.adobe.com

Background and Methods

Previous studies have explored the relationship between H. pylori infection and psoriasis, though results have not been entirely conclusive. Infection with H. pylori, a gram-negative bacteria, may be present in as many as half the world's population.²

A 2015 study published in Problems of Infectious and Parasitic Diseases reported the presence of H. pylori antibodies in 64% of patients with psoriasis, and in 33.3% of patients in the control groups.³ A study conducted out of Turkey just 4 years earlier reported the same number of positive H. pylori among both patients with psoriasis and controls representative of the general population.⁴

The present study sought to assess the relationship between psoriasis and the presence of H. pylori infection, noting past contradictory research and other findings that have indicated the potential of H. pylori to contribute to skin disorder manifestation.⁵

Researchers conducted a cross-sectional study between March 2023 to February 2024, categorizing patients with psoriasis (n=75) by severity and including a control group of patients (n=75). Participants provided detailed personal and medical histories and underwent a full dermatological examination to assess psoriasis severity. Researchers measured disease severity utilizing the Psoriasis Area and Severity Index (PASI) while measuring H. pylori stool antigen levels with an ELISA kit.

Findings

The average age for both groups was approximately 37 years, with a similar gender distribution observed. Individuals with psoriasis had an average Body Mass Index (BMI) of 24.33, compared to 23.79 in the control group, with a higher prevalence of comorbidites such as such as diabetes and hypertension observed in the psoriasis group.

Severity of psoriasis was evenly distributed among mild, moderate, and severe categories, with 25 patients in each category based on PASI scoring. Treatment regimens varied, with phototherapy being the most common (36%), followed by methotrexate (20%) and acitretin (4%).

Regarding H. pylori infection, researchers reported a significantly higher prevalence of H. pylori infection among patients with psoriasis (45.33%) compared to the control group (30.66%).

The study also explored correlations between H. pylori infection and various factors including disease severity, age, and duration of illness. Researchers reported no significant correlations with these tested variables. Further analysis did not reveal any substantial predictors of H. pylori infection in psoriasis, with variables such as age, sex, BMI, and psoriasis severity demonstrating no significant impact. Treatment types for psoriasis also did not correlate significantly with infection status.

Conclusions

"Psoriasis has been linked to an autoimmune mechanism and in vulnerable individuals, H. pylori has been linked to autoimmune processes," according to Abdel-Hamid et al.

The study may have been limited by a lack of multicentric research or long-term follow-up, and limited sample diversity. Study authors suggested that future research address these limitations, and that moving forward, patients with a high PASI score or significant body surface area involvement may benefit from screening for H. pylori.

References

1. Abdel-Hamid S, Abdel-Monem SA. Helicobacter pylori infection in psoriatic patients and its relation to psoriasis severity: cross sectional study. Skin Res Technol. August 21, 2024. https://doi.org/10.1111/srt.70005
2. Helicobacter pylori (H. pylori) infection. MayoClinic. Accessed August 23, 2024. https://www.mayoclinic.org/diseases-conditions/h-pylori/symptoms-causes/syc-20356171
3. Zhelezova G, Yocheva L, Tserovska L, Mateev G, Vassileva S. Prevalence of Helicobacter pylori seropositivity in patients with psoriasis. Probl Infect Parasit Dis. 2015; 43(1): 13-17.
4. Türkmen D, Özcan H, Kekilli E. Psoriazis ile Helicobacterpylori Enfeksiyonu Iliskisi/relation between psoriasis and Helicobacter pylori. Turk Dermatoloji Dergisi. 2011; 5: 39-42.
5. Hernando-Harder AC, Booken N, Goerdt S, Singer MV, Harder H. Helicobacter pylori infection and dermatologic diseases. Eur J Dermatol. 2009; 19(5): 431-444.