Prurigo Pigmentosa Literature Review Part 5 – Caused by H. Pylori?

Prurigo Pigmentosa Literature Review Part 5 – Caused by H. Pylori?

Here are links to the prior installments of this series:

• Prurigo Pigmentosa Literature Review Part 1
• Prurigo Pigmentosa Literature Review Part 2 – A Segmental Appearance
• Prurigo Pigmentosa Literature Review Part 3 – After a Strict Ketogenic Diet
• Prurigo Pigmentosa Literature Review Part 4 – Associated with Lyme Disease?

This was another paper that caught my attention because of the title which identified a specific organism in the skin biopsy of the prurigo pigmentosa rash.  This was published in the American Journal of Dermatopathology on June of 2012.

Identification of Helicobacter pylori in Skin Biopsy of Prurigo Pigmentosa

This was a case report on a 23 year old Chinese man who presented with a 3 year history of this rash with no reported history of fasting or dieting.  You can tell from the picture above that this had been going on for quite a while since it looks so dark and hyperpigmented.

They performed a skin biopsy from which they were able to isolate the Helicobacter pylori organism.  Blood tests also confirmed an an infection with H. pylori.

He was treated with the normal 14 day course of medications for H. pylori consisting of:

• Amoxicillin 1 gm, twice daily
• Clarithromycin 500 mg, twice daily
• Omeprazole 20 mg, twice daily

(Amoxicillin and Clarithromycin are both antibiotics.  Omeprazole is a proton pump inhibitor used to decrease acid production in the stomach)

The rash resolved after treatment and did not reappear over the 17 month course of followup.

The authors point out that:

Although others have considered that the chronic and recurrent nature of prurigo pigmentosa may imply a role of viral infection, infection with H. pylori is also often chronic and recurrent.

Other skin diseases, such as urticaria and prurigo nodularis, have been considered to be associated with gastric H. pylori infection by the ability to treat a subset of patients with these cutaneous disorders through H. pylori eradication.

This article along with the recent paper I discussed regarding a possible association with Lyme Disease would seem to suggest an underlying infectious source…  But as we can see, research in this area is sparse, and they have not been able to isolate a single organism consistently to narrow the field…

In any case, if you have the prurigo pigmentosa rash and have any symptoms of an H. pylori infection, this might be something worth looking into.

To the best of my knowledge I don’t think there’s any connection between ketosis and H. pylori flare-ups, so I don’t think this is too applicable in my case…