Skip to main content
Log in

Relationship Between Helicobacter pylori Infection and Vitiligo: A Prospective Study

  • Original Research Article
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Background

Helicobacter pylori is a worldwide bacteria that may affect several extra-gastric systems, including the endocrine, hematologic, vascular, respiratory, immune, and skin. Several skin diseases, including chronic urticaria, alopecia areata, psoriasis, and systemic lupus erythematosis have been found to be associated with H. pylori infection.

Aim

To our knowledge, there are no data showing an association between H. pylori and vitiligo. Therefore, in this study, we wanted to evaluate the relationship between H. pylori and vitiligo.

Methods

This study is a prospective study carried out in our Gastroenterology and Dermatology and Venereology departments of the Ankara Education and Research Hospital (Ankara, Turkey) between July 2013 and December 2013. Seventy-nine consecutive patients with vitiligo and 72 patients with telogen effluvium (TE) were recruited from the dermatology outpatient clinic. A total of 133 patients with vitiligo (n = 68) and TE (n = 65) [excluding 18 patients who had suspicious urea breath test (UBT) results] were included in the study. All individuals were tested for H. pylori IgG and CagA. Also, a UBT was performed to detect the presence of H. pylori infection.

Results

There were significantly higher rates of H. pylori positivity, H. pylori CagA, and IgG in serum in the vitiligo group than in the TE group (p < 0.05). The number of patients with dyspepsia was significantly higher in the vitiligo group than in the TE group. No statistically significant relationship was seen between H. pylori positivity, CagA, H. pylori IgG, dyspepsia, and the Vitiligo Disease Activity score (p > 0.05). Also, when patients with vitiligo were divided into localized and generalized types of vitiligo, there was no association between vitiligo involvement pattern and H. pylori positivity, CagA, H. pylori IgG, and dyspepsia (p > 0.05).

Conclusion

Additional studies are necessary to evaluate the effect of H. pylori eradication on the clinical course of vitiligo. Further studies are also needed to explain the relationship between H. pylori and the pathogenesis of vitiligo.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. McColl KE. Clinical practice. Helicobacter pylori infection. N Engl J Med. 2010;362:1597–604.

    Article  PubMed  CAS  Google Scholar 

  2. Konno M, Muraoka S, Takahashi M, Imai T. Iron-deficiency anemia associated with Helicobacter pylori gastritis. J Pediatr Gastroenterol Nutr. 2000;31:52–6.

    Article  PubMed  CAS  Google Scholar 

  3. Hino M, Yamane T, Park K, Takubo T, Ohta K, Kitagawa S, Higuchi K, Arakawa T. Platelet recovery after eradication of Helicobacter pylori in patients with idiopathic thrombocytopenic purpura. Ann Hematol. 2003;82:30–2.

    PubMed  CAS  Google Scholar 

  4. Shin DW, Kwon HT, Kang JM, Park JH, Choi HC, Park MS, Park SM, Son KY, Cho BJ. Association between metabolic syndrome and Helicobacter pylori infection diagnosed by histologic status and serological status. Clin Gastroenterol. 2012;46:840–5.

    Article  Google Scholar 

  5. Gerig R, Ernst B, Wilms B, Thurnheer M, Schultes B. Gastric Helicobacter pylori infection is associated with adverse metabolic traits in severely obese subjects. Obesity (Silver Spring). 2013;21:535–7.

    Article  CAS  Google Scholar 

  6. Doğan Z, Filik L, Ergül B, Sarikaya M, Akbal E. Association between Helicobacter pylori and liver-to-spleen ratio: a randomized-controlled single-blind study. Eur J Gastroenterol Hepatol. 2013;25:107–10.

    Article  PubMed  Google Scholar 

  7. Valsecchi R, Pigatto P. Chronic urticaria and Helicobacter pylori. Acta Derm Venereol. 1998;78:440–2.

    Article  PubMed  CAS  Google Scholar 

  8. Qayoom S, Ahmad QM. Psoriasis and Helicobacter pylori. Indian J Dermatol Venereol Leprol. 2003;69:133–4.

    PubMed  CAS  Google Scholar 

  9. Lankarani KB, Ravanbod MR, Aflaki E, Nazarinia MA, Rajaee A. High prevalence of Helicobacter pylori infection in Behcet’s disease. BMC Gastroenterol. 2014;31(14):58.

    Article  Google Scholar 

  10. Novák J, Csiki Z, Sebesi J, Takáts A, Demeter P, Sipka S. Elevated level of Helicobacter pylori antibodies in Henoch-Schonlein purpura [in Hungarian]. Orv Hetil. 2003;144:263–7.

    PubMed  Google Scholar 

  11. Njoo MD, Das PK, Bos JD, Westerhof W. Association of the Köbner phenomenon with disease activity and therapeutic responsiveness in vitiligo vulgaris. Arch Dermatol. 1999;135:407–13.

    PubMed  CAS  Google Scholar 

  12. Yamanishi S, Iizumi T, Watanabe E, Shimizu M, Kamiya S, Nagata K, Kumagai Y, Fukunaga Y, Takahashi H. Implications for induction of autoimmunity via activation of B-1 cells by Helicobacter pylori urease. Infect Immun. 2006;74:248–56.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  13. El Miedany YM, Baddour M, Ahmed I, Fahmy H. Sjogren’s syndrome: concomitant H. pylori infection and possible correlation with clinical parameters. Joint Bone Spine. 2005;72:135–41.

    Article  PubMed  Google Scholar 

  14. Takahashi T, Yujiri T, Shinohara K, Inoue Y, Sato Y, Fujii Y, et al. Molecular mimicry by Helicobacter pylori CagA protein may be involved in the pathogenesis of H. pylori-associated chronic idiopathic thrombocytopenic purpura. Br J Haematol. 2004;124:91–6.

    Article  PubMed  CAS  Google Scholar 

  15. Franceschi F, Christodoulides N, Kroll MH, Genta RM. Helicobacter pylori and idiopathic thrombocytopenic purpura. Ann Intern Med. 2004;140:766–7.

    Article  PubMed  Google Scholar 

  16. Röner S, Zinser E, Menges M, Wiethe C, Littmann L, Hänig J, et al. Minor role of bystander tolerance to fetal calf serum in a peptide-specific dendritic cell vaccine model against autoimmunity: comparison with serum-free cultures. J Immunother. 2008;31:656–64.

    Article  PubMed  Google Scholar 

  17. Shapira Y, Agmon-Levin N, Renaudineau Y, Porat-Katz BS, Barzilai O, Ram M, et al. Serum markers of infections in patients with primary biliary cirrhosis: evidence of infection burden. Exp Mol Pathol. 2012;93:386–90.

    Article  PubMed  CAS  Google Scholar 

  18. Tanaka A, Prindiville TP, Gish R, Solnick JV, Coppel RL, Keeffe EB, et al. Are infectious agents involved in primary biliary cirrhosis? A PCR approach. J Hepatol. 1999;31:664–71.

    Article  PubMed  CAS  Google Scholar 

  19. Vera JF, Gotteland M, Chavez E, Vial MT, Kakarieka E, Brunser O. Sucrose permeability in children with gastric damage and Helicobacter pylori infection. J Pediatr Gastroenterol Nutr. 1997;24:506–11.

    Article  PubMed  CAS  Google Scholar 

  20. Sagi L, Baum S, Agmon-Levin N, Sherer Y, Katz BS, Barzilai O, et al. Autoimmune bullous diseases the spectrum of infectious agent antibodies and review of the literature. Autoimmun Rev. 2011;10:527–53.

    Article  PubMed  Google Scholar 

  21. Ram M, Barzilai O, Shapira Y, Anaya JM, Tincani A, Stojanovich L, et al. Helicobacter pylori serology in autoimmune diseases - fact or fiction? Clin Chem Lab Med. 2013;51:1075–82.

    Article  PubMed  CAS  Google Scholar 

  22. Kivity S, Arango MT, Ehrenfeld M, Tehori O, Shoenfeld Y, Anaya JM, et al. Infection and autoimmunity in Sjogren’s syndrome: a clinical study and comprehensive review. J Autoimmun. 2014;14:53–5.

    Google Scholar 

  23. Nelson P, Rylance P, Roden D, Trela M, Tugnet N. Viruses as potential pathogenic agents in systemic lupus erythematosus. Lupus. 2014;23:596–605.

    Article  PubMed  CAS  Google Scholar 

  24. Andreakos E. Targeting cytokines in autoimmunity: new approaches, new promise. Expert Opin Biol Ther. 2003;3:435–47.

    Article  PubMed  CAS  Google Scholar 

  25. Forabosco P, Gorman JD, Cleveland C, Kelly JA, Fisher SA, Ortmann WA, et al. Meta-analysis of genome-wide linkage studies of systemic lupus erythematosus. Genes Immun. 2006;7:609–14.

    Article  PubMed  CAS  Google Scholar 

  26. Roessner K, Wolfe J, Shi C, Sigal LH, Huber S, Budd RC. High expression of Fas ligand by synovial fluid-derived γδ T cells in Lyme arthritis. J Immunol. 2003;170:2702–10.

    Article  PubMed  CAS  Google Scholar 

  27. Sahashi K, Engel AG, Linstrom JM, Lambert EH, Lennon VA. Ultrastructural localization of immune complexes (IgG and C3) at the end plate in experimental autoimmune myasthenia gravis. J Neuropathol Exp Neurol. 1978;37:212–23.

    Article  PubMed  CAS  Google Scholar 

  28. Herzum M, Ruppert V, Küytz B, Jomaa H, Nakamura I, Maisch B. Coxsackievirus B3 infection leads to cell death of cardiac myocytes. J Mol Cell Cardiol. 1994;26:907–13.

    Article  PubMed  CAS  Google Scholar 

  29. Ishida Y, Suzuki K, Taki K, Niwa T, Kurotsuchi S, Ando H, et al. Significant association between Helicobacter pylori infection and serum C-reactive protein. Int J Med Sci. 2008;5(4):224–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  30. Bergman MP, Vandenbroucke-Grauls CM, Appelmelk BJ, D’Elios MM, Amedei A, Azzurri A, et al. The story so far: Helicobacter pylori and gastric autoimmunity. Int Rev Immunol. 2005;24:63–91.

    Article  PubMed  CAS  Google Scholar 

  31. Toh BH. Diagnosis and classification of autoimmune gastritis. Autoimmune Rev. 2014;13:549–62.

    Article  Google Scholar 

  32. Onsun N, Arda Ulusal H, Su O, Beycan I, Biyik Ozkaya D, Senocak M. Impact of Helicobacter pylori infection on severity of psoriasis and response to treatment. Eur J Dermatol. 2012;22:117–20.

    PubMed  Google Scholar 

  33. Magen E, Mishal J. Possible benefit from treatment of Helicobacter pylori in antihistamine-resistant chronic urticaria. Clin Exp Dermatol. 2013;38:7–12.

    Article  PubMed  CAS  Google Scholar 

  34. Bruscky DM, da Rocha LA, Costa AJ. Recurrence of chronic urticaria caused by reinfection by Helicobacter pylori. Rev Paul Pediatr. 2013;31:272–5.

    Article  PubMed  Google Scholar 

  35. Ersoy O, Ersoy R, Yayar O, Demirci H, Tatlican S. H pylori infection in patients with Behcet’s disease. World J Gastroenterol. 2007;13:2983–5.

    PubMed  Google Scholar 

  36. Apan TZ, Gürsel R, Dolgun A. Increased seropositivity of Helicobacter pylori cytotoxin-associated gene-A in Behçet’s disease. Clin Rheumatol. 2007;26:885–9.

    Article  PubMed  Google Scholar 

  37. Avci O, Ellidokuz E, Simşek I, Büyükgebiz B, Güneş AT. Helicobacter pylori and Behçet’s disease. Dermatology. 1999;199:140–3.

    Article  PubMed  CAS  Google Scholar 

  38. Ongenae K, Van Geel N, Naeyaert JM. Evidence for an autoimmune pathogenesis of vitiligo. Pigment Cell Res. 2003;16:90–100.

    Article  PubMed  Google Scholar 

  39. Zhang BX, Lin M, Qi XY, Zhang RX, Wei ZD, Zhu J, et al. Characterization of circulating CD8 + T cells expressing skin homing and cytotoxic molecules in active non-segmental vitiligo. Eur J Dermatol. 2013;23:331–8.

    PubMed  CAS  Google Scholar 

  40. Sravani PV, Babu NK, Gopal KV, Rao GR, Rao AR, Moorthy B. Determination of oxidative stress in vitiligo by measuring superoxide dismutase and catalase levels in vitiliginous and non-vitiliginous skin. Indian J Dermatol Venereol Leprol. 2009;75:268–71.

    Article  PubMed  CAS  Google Scholar 

  41. Kovacs SO. Vitiligo. J Am Acad Dermatol. 1998;38:647–67.

    Article  PubMed  CAS  Google Scholar 

  42. Toussaint S, Kamino H, Elder D, Elenitas R, Jaworsky D, Johnson B. Noninfectous papular and squamous diseases. In: Elder D, Elenitsas R, Jaworsky C, Johnson Jr B, editors. Lever’s histopathology of the skin. 8th ed. Philadelphia: Lippincott-Raven; 1997:154–5.

  43. Schallreuter KU, Wood JM, Pittelkow MR, Gütlich M, Lemke KR, Rödl W, et al. Regulation of melanin biosynthesis in the human epidermis by tetrahydrobiopterin. Science. 1994;263:1444–6.

    Article  PubMed  CAS  Google Scholar 

  44. Abdel Naser MB, Krüger-Krasagakes S, Krasagakis K, Gollnick H, Orfanos CE. Further evidence for involvement of both cell mediated and humoral immunity in generalized vitiligo. Pigment Cell Res. 1994;7:1–8.

    Article  PubMed  CAS  Google Scholar 

  45. Naughton GK, Eisinger M, Bystryn JC. Detection of antibodies to melanocytes in vitiligo by specific immunoprecipitation. J Invest Dermatol. 1983;81:540–2.

    Article  PubMed  CAS  Google Scholar 

  46. Crabtree JE, Shallcross TM, Heatley RV, Wyatt JI. Mucosal tumour necrosis factor alpha and interleukin-6 in patients with Helicobacter pylori associated gastritis. Gut. 1991;32:1473–7.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  47. Crabtree JE, Wyatt JI, Trejdosiewicz LK, Peichl P, Nichols PH, Ramsay N, et al. Interleukin-8 expression in Helicobacter pylori infected, normal, and neoplastic gastroduodenal mucosa. J Clin Pathol. 1994;47:61–6.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  48. Fan XG, Chua A, Fan XJ, Keeling PW. Increased gastric production of interleukin-8 and tumour necrosis factor in patients with Helicobacter pylori infection. J Clin Pathol. 1995;48:133–6.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  49. Noach LA, Bosma NB, Jansen J, Hoek FJ, van Deventer SJ, Tytgat GN. Mucosal tumor necrosis factor α, interleukin 1 beta, and interleukin 8 production in patients with Helicobacter pylori infection. Scand J Gastroenterol. 1994;29:425–9.

    Article  PubMed  CAS  Google Scholar 

  50. Moss SF, Legon S, Davies J, Calam J. Cytokine gene expression in Helicobacter pylori associated antral gastritis. Gut. 1994;35:1567–70.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  51. Warzecha Z, Dembiński A, Ceranowicz P, Dembiński M, Sendur R, Pawlik WW, et al. Deleterious effect of Helicobacter pylori infection on the course of acute pancreatitis in rats. Pancreatology. 2002;2(4):386–95.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

No sources of funding were used to conduct this study or prepare this manuscript. Zeynal Doğan, Pinar Özdemir, Meral Ekşioğlu, and Levent Filik have no conflicts of interest that are directly relevant to the content of this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Zeynal Doğan.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Doğan, Z., Özdemir, P., Ekşioğlu, M. et al. Relationship Between Helicobacter pylori Infection and Vitiligo: A Prospective Study. Am J Clin Dermatol 15, 457–462 (2014). https://doi.org/10.1007/s40257-014-0087-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-014-0087-3

Keywords

Navigation