A conexão Gut-Face em Rosácea: Explorando o papel de H. pylori
janeiro 07, 2019
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Emerging evidence points to a potential link between H pylori infection and skin diseases including rosacea.
An estimated 25% para 30% of the general population is infected withHelicobacter pylori (H pylori), a gram-negative bacterium that represents a major cause of stomach ulcers and other gastric issues.1Research findings increasingly suggest a connection betweenH pyloriinfection and various other medical conditions, such as Parkinson disease, migraines, and iron deficiency anemia.2 Além, emerging evidence points to a potential link betweenH pyloriinfection and skin diseases includingrosácea.
Numerous studies have demonstrated higher rates ofH pyloriinfection in patients with rosacea compared with control subjects. Por exemplo, prospective research published in 2015 tested 90 patients with rosacea and 90 control subjects forH pylori (using the 13C Urea Breath Test andH pyloristool antigen test) and found infection rates of 48.9% e 26.7%, respectivamente (P =.003).1Similar results were not found for small intestinal bacteria overgrowth.
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Dentro 10 weeks following treatment with clarithromycin-containing sequential therapy, skin lesions had decreased significantly or completely resolved in 97.2% of patients in whomH pyloriwas eradicated (P <.0001). For cases in which treatment did not eradicateH pyloriinfection, lesions were reduced or eliminated in 37.5% dos pacientes. These results align with those of many other studies showing a higher prevalence ofH pyloriin patients with rosacea vs controls and showing resolution of symptoms following eradication of the bacteria.
Among the potential mechanisms underlying these associations, increased levels of reactive oxygen species and nitric oxide byH pylorihave been associated with inflammation and vasodilatation in rosacea.3Other evidence has revealed that “cytotoxin-associated gene A, known as aH pylorivirulence factor, facilitated the secretion of proinflammatory cytokines in the gastric epithelium, and the presence of cytotoxin-associated gene A antibodies was observed in patients with rosacea.”3
Several other studies, contudo, have not found a higher prevalence ofH pyloriin people with rosacea or an improvement in symptoms after eradication ofH pylori. As rosacea is a multifactorial disease, it is possible thatH pyloriis a contributing factor in certain patients with specific subtypes of the disease. In support of this, some studies have noted a more favorable treatment response among patients with papulopustular rosacea compared with other subtypes.
One such investigation conducted in 2012 found more frequent rates of gastric ulceration and an especially high response to eradication therapy in patients with papulopustular rosacea.4The study authors concluded that “H pyloriplays an important role in rosacea patients with concomitant dyspeptic problems, especially in the papulopustular subtype.”
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It is also notable that there are different strains ofH pyloriwith varying levels of virulence, a range of statistical methods and assessments forH pylorihave been used in studies on the topic, and the previous use of antibiotics in people with rosacea may influence results.4These factors may further explain the divergent findings observed across studies. Additional research is needed to clarify these points.
Dermatologia Advisorspoke with Suzan Obagi, MD, director of the UPMC Cosmetic Surgery and Skin Health Center and the 2018 president of the American Academy of Cosmetic Surgery, regarding the potential significance ofH pyloriin rosacea.
Dermatologia Advisor:What does the research suggest thus far about associations between rosacea andH pylori, as well as underlying mechanisms?
Dr Obagi:There is growing evidence of the link between what we eat and drink and inflammation in the body and skin. Like the digestive tract, skin is one of the largest organs and has its own immune system, and the link between these 2 systems is becoming clearer. The foods and drinks we consume can alter the gut microbiome, allowing unhealthier bacteria to grow and crowd out the healthier bacteria.
It turns out that the unhealthy bacteria can damage the intestinal lining and cause the gut to become “leaky,” thus allowing substances to enter the bloodstream that should be kept out. These are inflammatory substances, immune triggering proteins, and the very harmful endotoxins produced by bacteria. Adicionalmente, ingesting even moderate amounts of alcohol can reduce the production of healthy bile acids by our gut and thus foster the growth of unhealthy bacteria. Por último, high glycemic foods can feed the unhealthy bacteria and increase the systemic inflammatory response.
There is growing scientific evidence that gut health is intricately linked with overall health, beyond just skin. We are now finding ties between the microbiome and dementia, diabetes, heart disease, cancer, and skin conditions. H pyloriis probably just one small example of this issue. H pyloriinfection causes stomach ulcers in many people but can be silent in others.
In some patients with active infection, their skin shows symptoms of inflammation such as a rosacea flare. In these people, treating the infection can help clear their skin. Contudo, for some people with rosacea, they have active rosacea and noH pyloriinfection. That suggests a different contributing factor, and other causes of gut issues should be considered.
We know that there is a link between the skin and the gut in atopic dermatitis, acne, rosácea, and now, based on some convincing studies, probably a link with psoriasis, hidradenitis suppurativa, pioderma gangrenoso, and inflammatory bowel disease as well.
Dermatologia Advisor: What are additional treatment recommendations for clinicians?
Dr Obagi:I think that any clinician who is keeping up with the science is starting to have discussions with their patients about mediating inflammation, which is the root cause of most of the conditions I mentioned above. One of the ways our patients can mitigate inflammation is to improve their overall gut health by taking probiotics (especially after taking antibiotics); eating a low glycemic diet; avoiding inflammatory foods such as dairy, gluten, soy, and peanuts; eliminating sugary drinks; and keeping alcohol intake to a minimum.
Some patients may also require supplementation with vitamins such as quercetin and digestive acids such as bile acids for certain conditions. These suggestions should be implemented in collaboration with the patient’s primary care provider and dermatologist.
Dermatologia Advisor:What are some of the remaining research needs in this area?
Dr Obagi:We need more research on a larger population of patients of various ethnicities to see whether this link pans out across ethnically different patients. We are already hearing of universities investing in studying the gut microbiome and using that knowledge to create a clinic to evaluate and treat patients based on this research.