Correspondence Psoriasis and small intestine bacterial overgrowthIn psoriasis, the alteration of intestinal microbiota that characterizes the syndrome of small intestinal bacterial overgrowth (SIBO) may influence the immune homeostasis determining one proinflammatory status. 1 In subjects with psoriasis, we investigated the prevalence of SIBO and its possible influence on the clinical course of the disease, especially on the inflammatory component of the psoriatic plaques.Thirty patients with psoriasis (14 women and 16 men, mean age 39 years) were recruited and studied prospectively. Clinically, they showed active psoriatic manifestations resistant to topical and systemic medications. They had no history of bowel diseases. All patients underwent a dermatological examination to assess: (1) type of psoriasis (plaque, guttate, inverse, erythrodermic); (2) psoriasis severity (mild, moderate, severe) using the Psoriasis Area Severity Index (PASI); (3) severity of the erythema in the psoriatic plaques as evaluated by the colorimeter ChromaMeter CR200 (Minolta, Milano). The skin was considered inflamed when the colorimetric values were ≥12.Subsequently, after suitable preparation, the patients were subjected to a glucose breath test (GBT) to investigate the presence of SIBO. Whenever the test was positive, the patient was treated with rifaximin (1200 mg/day for 12 days) in combination with partially hydrolyzed guar gum (GG) (5 g/day). In fact, the combination of rifaximin with partially hydrolyzed GG, a prebiotic that can have a beneficial effect on intestinal motility, seems to be more useful in eradicating SIBO compared with rifaximin alone. 2 Moreover, rifaximin is similar to rifampin which, besides the antibacterial action, has been shown to be a biofilm-dispersing agent.
3The efficacy of the eradication therapy was evaluated with a new GBT a month later. Furthermore, all patients underwent another dermatological examination to evaluate the eradication effect on the skin by repeating the PASI and chromameter evaluation. A control group of 60 healthy volunteers was analyzed using the same procedure.The psoriatic skin had colorimetric values (mean 15.53 AE 1.97) significantly higher than the skin of healthy volunteers (mean 6.23 AE 2.00) (P < 0.001). The prevalence of SIBO in psoriatic patients (3 of 30, 10%) did not differ statistically from the control group (3 of 60, 5%) (P = 0.6). Rifaximin-GG treatment markedly improved the inflammation in the lesions of positive SIBO psoriatic patients compared with their nonlesional skin. More specifically, the erythema intensity was reduced by 43% in the three evaluated plaques. The GBT test performed after the antibiotic treatment in the three psoriasis patients with SIBO confirmed the efficacy of the eradication therapy in all cases.The prevalence of SIBO in patients with psoriasis is comparable to that in the control group. This is in contrast with a previous study that claimed SIBO prevalence to be higher in psoriatic however, the difference is not statistically significa...