Clinicoepidemiological study in Sudanese patients: Prevalence and effect of eradicative triple therapy on extra digestive Helicobacter pylori skin manifestations, EdHpSm

Bashir A. H. H.¹,^2*, Yousif S. M.² and Mahmoud M. O. A.²

¹Department of Dermatology and Venereology, Al Jawda Medical Centre, University of Juba, P. O. Box 1347, Khartoum, Sudan.

²Khartoum College of Medical Science, Jabir AbuEliz Diabetic Centre, Sudan.

*Corresponding author. E-mail: derma55@yahoo.com.

Accepted 30 December, 2010

Abstract

Helicobacter pylori are gram-negative; microaerophilic spiral rod-shaped bacteria and they lead to gastritis, duodenal or gastric ulcer and even in rare cases to gastric carcinoma or Mucosa Associated Lymphoid Tissue (MALT) lymphoma. Based on a number of reports, a possible relationship of H. pylori infection to a variety of different dermatosis has been suggested, including urticaria, rosacea, acne-rosacea, atopic dermatitis, alopecia areata, Sjögren’s syndrome, Schönlein-Henoch purpura, and Sweet’s syndrome. This study is intended to identify the prevalence of extra digestive (extra gastric) H. pylori skin manifestations, and to observe the influence of H. pylori eradication through triple therapy on the clinical evolution of patients' skin conditions. A clinical descriptive study of 149 patients with skin manifestations and immunologically detected H. pylori by rapid test, in association with gastric, chest, joints and nasal symptoms were considered as study population. H. pylori (Hp) triple therapy have been given to all positive cases as first, second and relapse modality in 12 weeks duration treatment, 4 weeks interval each with no any added other type of treatment allowed.  The study revealed that: 20.5% of the skin cases examined (3723) were considered extradigestive H. pylori skin manifestation (746). Most of the skin manifestations cases were females (67.1%), and approximately 60.4% of EdHpSm were at the age group 14 to 45 yr- old. Most of the patients with EdHpSm are of Northern Sudanese origin (87.2%), the Southerners, the Easterners and the Westerners showed lower percentages, that is, 1.3, 3.4 and 8.1%, respectively. EdHpSm is common among professional. Hay fever and gingival disease were among the most commonly associated diseases where they represented ca. 27.7 and 12.2%, respectively.  Chronic Idiopathic Urticaria, CIU represent a higher prevalence (20.6%), where: Polymorphous Light Eruption (PLE) alone represented 12.7%, and Polycystic Ovary Syndrome, PCO was 11.6%. Vitiligo 2.6% among the least presented cases. Consequently, it was concluded that: all cases of EdHpSm responded to triple therapy; 60.0% are of good response and 37.0% are dramatically responded to triple therapy, while 2.0% poorly responded to therapy. H. pylori infection found to have an important role in the etiology of chronic idiopathic urticaria, Urticarial vasculitis, and Atopic dermatitis and other skin diseases. Patients received antimicrobial triple therapy, found to respond dramatically in (37%). 

Key words: Immunologically, lymphoma, lymphoid, Helicobacter pylori.