An H. Pylori Infection Does Not Impact the Severity of Psoriasis

Credit: Adobe Stock/ Dragana Gordic

A new study found patients with psoriasis have greater rates of a helicobacter pylori (H. pylori) infection, but this does not impact the severity of psoriasis.¹

“Although a variety of diseases have been suggested as the origin of psoriasis, research linking H. pylori to the illness is still relatively new,” wrote investigators, led by Soheir Abdel-Hamid, MD, from the department of dermatology, venereology, and andrology from South Valley University in Egypt. “It is currently unclear how the bacterium can induce psoriasis, and it is also unclear if H. pylori can cause skin diseases.”

However, research has demonstrated patients with severe psoriasis (79%), compared to those with intermediate (69.5%) or mild (46.2%) psoriasis, have a greater seroprevalence of H. pylori infection.² A meta-analysis also showed patients with psoriasis had a greater prevalence of H. pylori infection than controls.³

H. Pylori has been shown to lead to some skin disorders, such as cutaneous pruritus, Behçet's disease, nodular prurigo, and lichen planus.⁴ Thus, investigators wanted to better understand the relationship between psoriasis severity and H. pylori infection.¹ The team conducted a cross-sectional study to examine the prevalence of H. pylori infection in patients with psoriasis compared to healthy controls, as well as to determine whether H. pylori impacted the severity of psoriasis.

Participants were matched for age (P = .908); the mean age of the psoriasis arm was 37.44 ± 15.79 years, and the mean age of the control arm was 37.15 ± 15.15 years. Participants had a mean duration of psoriasis of 4.94 ± 4.25 years.

Regarding psoriasis sites, 80% were in the upper limbs, 85.33% were in the lower limbs, 61.33) were on the head, 50.67% were in the trunk, and 2.67% In the back. Moreover, 34.67% of participants had nail psoriasis and 4% had joint psoriasis.

The psoriasis arm was divided into the subgroups: mild moderate, and severe, each consisting of 25 patients. The severity of psoriasis was determined based on the Psoriasis Area Severity Index (PASI score).

Although the study included controls, the team also measured the H. Pylori antigen from both arms by using a test for H. pylori stool antigen: H. pylori stool antigen-enzyme linked immunosorbent assay. With the test, ≥ 20 ng/mL of antigen indicated a positive result and ≤ 15 ng/mL indicated a negative result. The stool antigen test has an accuracy of > 90%.

“This rapid test is helpful for both diagnosis and verifying the continued presence of organisms following therapy,” investigators wrote. “Serology tests are not helpful in areas with low infection frequency while having varying rates of specificity (59.6% to 97.9%) and sensitivity (55.6% to 100%). Its inability to distinguish between current and previous infections is another drawback.”

Patients with psoriasis (45.33%) and healthy controls (30.66%) had significant differences in the prevalence of an H. pylori infection (P = .046). Moreover, investigators observed no significant correlation between H. pylori infection and PASI (P = 1.00), age (P = 0.716), or illness duration (P = 0.787) in patients with psoriasis.

Investigators wrote the relationship between psoriasis severity and H. pylori infection needs to be conducted in larger multicenter research where H. pylori is eliminated in patients with psoriasis who have positive antigen—especially for individuals who had a high BSA or PASI score, severe psoriasis, and had psoriasis for a long duration. The team also recommended future studies should screen for H. pylori infection.

“The current debate over the connection between H. pylori infection and psoriasis may be brought about by variations in sample sizes, illness severity, and public health level,” investigators wrote. “Therefore, it seems unclear how psoriasis and H. pylori infection are related. Ultimately, additional research is required to shed light on this matter.”

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. 2024;30(8):e70005. doi:10.1111/srt.70005}
2. ^{Mesquita PM, Filho Diogo A, Jorge MT, et al. Relationship of Helicobacter pylori seroprevalence with the occurrence and severity of psoriasis. An Bras Dermatol. 2017; 92: 52-57.}
3. ^{Yu M, Zhang R, Ni P, Chen S, Duan G. Helicobacter pylori infection and psoriasis: a systematic review and meta-analysis. Medicina (Kaunas). 2019; 55(10): 645.}
4. ^{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. doi:10.1684/ejd.2009.0739}