Jak ostrzegają eksperci, nie lekceważmy zmian pojawiających się na skórze, ponieważ mogą się one wiązać z rozpoznaniem stanu zapalnego lub nowotworu przewodu pokarmowego. Nawet u 1/3 pacjentów z chorobą układu pokarmowego mogą wystąpić takie zmiany skórne jak bolesne, czerwone guzy, guzki czy krostki ulegające wrzodzeniu.
Zmiany te mogą pojawić się już na kilka tygodni czy miesięcy przed rozpoznaniem stanu zapalnego lub nowotworu przewodu pokarmowego.
– Skóra mówi dużo o kondycji naszego organizmu. Wiele chorób internistycznych można rozpoznać po kolorze i stanie skóry. Mogą się objawiać zasinieniem, zażółceniem lub bladością skóry. W wielu przypadkach, różne objawy skórne wyprzedzają, nawet o wiele miesięcy, objawy chorób przewodu pokarmowego – podkreśliła dr Magdalena Kędzierska z Kliniki Dermatologii Centralnego Szpitala Klinicznego MSWiA w Warszawie.
Diagnostyka zmian skórnych w kierunku chorób układu pokarmowego
Ze względu na to, że część zmian skórnych, takich jak grudki, guzki, pęcherzyki, krostki lub owrzodzenia jest bardzo charakterystyczna dla określonych chorób, ważne jest aby w ich kierunku prowadzić diagnostykę.
– Wśród chorób układu pokarmowego, którym najczęściej towarzyszą zmiany skórne, wymienić należy przede wszystkim nieswoiste zapalne choroby jelit, czyli chorobę Leśniowskiego-Crohna i wrzodziejące zapalenie jelita grubego – mówi dr n. med. Irena Walecka, kierownik Kliniki Dermatologii Centralnego Szpitala Klinicznego MSWiA w Warszawie.
Rumień guzowaty i piodermia zgorzelinowa jako najczęstsze objawy zmian skórnych
Wśród najczęstszych objawów zmian skórnych, które towarzyszą chorobie z różnym nasileniem, a także w różnych etapach choroby podstawowej jest rumień guzowaty i piodermia zgorzelinowa.
Rumień guzowaty występuje pod postacią bolesnych guzów i guzków. Pojawiają się one nagle, najczęściej u kobiet, na przedniej powierzchni podudzi. Dotyczą ok. 15% pacjentów z nieswoistymi zapalnymi chorobami jelit.
Pierwotnie zmiany te przybierają kolor czerwony, później brunatny a następnie żółtozielony. Nie towarzyszy im owrzodzenie, jak również nie pozostawiają blizn po sobie. Zmiany zazwyczaj ustępują po trzech/ sześciu tygodniach.
Piodermia zgorzelinowa natomiast to czerwone, zapalne guzki lub krosty. Zmiany te najczęściej występują na kończynach dolnych. Bardzo szybko się rozprzestrzeniają. Nie leczone są śmiertelne, natomiast leczone towarzyszą pacjentowi wiele miesięcy, a nawet lat. Wówczas nie pozostawiają blizny. Etiologia tej rzadkiej choroby nie jest znana. Wiadomo natomiast, że dotyczy ok. 5% chorych z wrzodziejącym zapaleniem jelita grubego oraz około 2 proc. pacjentów z chorobą Leśniowskiego-Crohna.
Jaki związek ze zmianami skórnymi ma niedobór cynku?
Zmiany skórne mogą być również spowodowane upośledzonym wchłanianiem pokarmów, a dokładniej nieprawidłowym wchłanianiem witamin i minerałów. M.in. niedobór cynku w organizmie, niezależnie od tego czy brakuje go z uwagi na nieodpowiednią dietę czy upośledzenie jego wchłaniania, może być przyczyną rumieniowo-złuszczających zmian pokrytych nadżerkami i strupami. Pojawiają się najczęściej w niedaleko naturalnych otworów, a także na wewnętrznych częściach kończyn.
U większości pacjentów strup występuje w centralnej części zmiany, natomiast wokół obwodu występują krostki i pęcherzyki. Zmiany te towarzyszą najczęściej w przebiegu choroby zapalnej jelit, zapalenia trzustki czy przewlekłej choroby nerek. Mogą one również występować na włosach w postaci naturalnych pasemek na włosach, które mają związek ze zmianami stężenia cynku w organizmie.
Zmiany skórne w przypadku zakażenia przewodu pokarmowego
Objawy w postaci zmian skórnych mogą być również spowodowane zakażeniem przewodu pokarmowego.
– W przebiegu zakażeń pasożytniczych, takich jak: lamblia, owsik, glista, tasiemiec uzbrojony i nieuzbrojony, może się pojawiać wiele zmian o charakterze bąbli pokrzywkowych. Zakażeniom bakteryjnym typu Salmonella, Shigella, może towarzyszyć, m.in.: rumień guzowaty – mówi dr Irena Walecka.
Związek trądziku różowatego z zakażeniem bakterią Helicobacter pylori
Jak potwierdza ekspertka, trądzik różowaty może występować w przebiegu infekcji Helicobacter pylori. Ta przewlekła choroba ograniczona do skóry twarzy najczęściej dotyczy kobiet, jednak jej cięższy przebieg dotyka mężczyzn. Początkowo zmiany mają charakter rumieniowy z zaczerwienieniem skóry twarzy, które przemija.
Następnie zmiany przybierają postać wykwitów grudkowych i krostkowych. Pojawiają się w środkowej części twarzy, na nosie, policzkach i czole i niekiedy są podobne do objawów chociażby tocznia.
– W części przypadków, trądzik różowaty może współistnieć z infekcją Helicobacter pylori. Związek pomiędzy trądzikiem różowatym a tą infekcją jest wciąż niejasny i nie ma na to pewnych dowodów. Niemniej u części pacjentów trądzik ustępuje po wyleczeniu infekcji Helicobacter pylori – mówi dr Irena Walecka.
Choroba nowotworowa a zmiany skórne
Zmiany skórne, które nie wykazują efektów w standardowym leczeniu powinny skłonić specjalistę do diagnostyki w kierunku choroby nowotworowej, ponieważ mogą to być zespoły paraneoplastyczne (zmiany skórne, towarzyszące procesom nowotworowym).
Aby potwierdzić diagnozę muszą być spełnione takie kryteria, jak np. wystąpienie nietypowych objawów skórnych opornych na standardowe leczenie, ustąpienie zmian skórnych wraz z podjęciem właściwego leczenia nowotworu i nawrót zmian przy wznowie procesu nowotworowego, jak również
Chorobą nowotworową, której towarzyszą zmiany skórne jest m.in. rogowacenie ciemne, które występuje razem z gruczolakorakiem żołądka. Wśród jej głównych objawów jest brodawkowaty, symetryczny przerost skóry, któremu towarzyszy świąd. Najczęściej zmiany występują w zgięciach i fałdach skórnych, niekiedy również na powiekach i wargach, a nawet śluzówce jamy ustnej.
Rogowacenie ciemne na dłoniach może mieć związek z rakiem oskrzeli i rakiem żołądka. Nagłe wystąpienie licznych brodawek łojotokowych, któremu towarzyszy świąd może również wskazywać na nowotwór np. gruczolakorak przewodu pokarmowego.
Źródło: zdrowie.pap.pl
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