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Choroba Leśniowskiego-Crohna i wrzodziejące zapalenie jelita grubego mogą manifestować się na skórze, np. poprzez rumień guzowaty, łuszczycę czy zgorzelinowe zapalenie skóry. U niektórych pacjentów zmiany skórne mogą być pierwszym objawem rozwijającej się choroby układu pokarmowego.
Często to właśnie problemy dermatologiczne pojawiają się jako pierwsze w obrazie klinicznym, a dolegliwości ze strony przewodu pokarmowego dołączają po pewnym czasie. Zmiany skórne stanowią jeden z elementów diagnostycznych, dlatego duże znaczenie w diagnostyce chorób układu pokarmowego ma zatem współpraca dermatologów i gastroenterologów.
Jakie zmiany skórne mogą współistnieć z nieswoistymi chorobami zapalnymi jelit?
Choroba Leśniowskiego-Crohna i wrzodziejące zapalenie jelita grubego (WZJG) należą do nieswoistych chorób zapalnych jelit. Schorzenia te często manifestują się również pozajelitowo, na skórze. Częstość występowania zmian skórnych w przebiegu nieswoistych chorób zapalnych jelit określa się w przedziale od 2 do 53 proc.
- Rumień guzowaty – występuje u około 15 proc. chorych na chorobę Leśniowskiego-Crohna lub WZJG. Zmiany charakteryzują się występowaniem tkliwych, czerwonobrunatnych guzów zapalnych o średnicy od 1 do 5 cm. W większości przypadków zmiany zlokalizowane są na przedniej części podudzi lub na przedramionach (rzadziej). Rumień guzowaty zazwyczaj ustępuje po około 2 tygodniach – zmiany spłaszczają się i bledną nie pozostawiając po sobie śladu. Ich występowaniu mogą towarzyszyć objawy ogólne, takie jak gorączka, powiększenie węzłów chłonnych, złe samopoczucie.
- Piodermia zgorzelinowa (zgorzelinowe zapalenie skóry) – częściej obserwowana jest u pacjentów z WZJG (około u 5 proc.) niż z chorobą Leśniowskiego-Crohna (około 2 proc.). Zgorzelinowe zapalenie skóry charakteryzuje się błyskawicznie pojawiającymi się owrzodzeniami ze słabą granicą i uniesionym, nieregularnym brzegiem. Zmiany są bolesne lub tkliwe i utrzymują się przez wiele miesięcy lub lat, a także pozostawiają po sobie blizny. Owrzodzenia najczęściej pojawiają się na kończynach dolnych, jednak mogą objąć inne miejsca na ciele.
- Zespół Sweeta (pokrewna piodermii zgorzelinowej) – to rzadka neutrofilowa dermatoza, która również może współistnieć z nieswoistymi chorobami zapalnymi jelit. Schorzenie objawia się bolesnymi, rumieniowo-obrzękowymi lub guzowatymi naciekami zlokalizowanymi na skórze twarzy, tułowia, szyi lub kończyn. Na obwodzie zmian niekiedy obserwowane jest tworzenie się drobnych pęcherzyków lub krostek. Zmianom skórnym może towarzyszyć gorączka, bóle stawów i złe samopoczucie.
- Aftowe zapalenie jamy ustnej – w obrazie klinicznym obserwowane są liczne płytkie nadżerki śluzówki z sadłowatym dnem i rumieniową obwódką. Schorzenie jest przewlekłe, a pacjenci skarżą się na występowanie bolesności, która utrudnia przyjmowanie pokarmów.
- Łuszczyca – może występować nawet u 11 proc. pacjentów z nieswoistymi chorobami zapalnymi jelit. Schorzenie objawia się występowaniem rumieniowych grudek i tarczek pokrytych warstwą łuski. Zmiany najczęściej zlokalizowane są na łokciach, kolanach, okolicach krzyżowo-lędźwiowych.
- Bielactwo – schorzenie może współwystępować z nieswoistymi chorobami zapalnymi jelit, chociaż nie wyjaśniono dotąd między nimi związku. Bielactwo występuje w dowolnej lokalizacji na ciele i objawia się plamami niedobarwliwymi.
- Pęcherzowe oddzielanie się naskórka EBA (epidermolysis bullosa aqusita) – również nie wyjaśniono związku występowania tego schorzenia wraz z nieswoistymi chorobami zapalnymi jelit. EBA objawia się występowaniem na skórze dobrze napiętych pęcherzy, najczęściej na łokciach, kolanach, stopach i rękach. Pękające pęcherze mogą pozostawiać po sobie rozległe nadżerki i owrzodzenia gojące się przez bliznowacenie.
- Acrodermatitis enteropatica – to choroba będąca powikłaniem choroby Leśniowskiego-Crohna i WZJG, wynikająca z zaburzeń wchłaniania witamin i minerałów, której istotą jest niedobór cynku. Schorzenie objawia się ostro odgraniczonymi plamami pokrytymi nadżerkami i strupami. Najczęściej zmiany zlokalizowane są w okolicach twarzy, narządów moczowo-płciowych, stopach i rękach.
- Choroba Dühringa – opryszczkowate zapalenie skóry o podłożu autoimmunologicznym. Zmiany skórne mogą przybierać postać rumienia, pęcherzyków, pęcherzy, grudek i krost o układzie opryszczowatym z towarzyszącym intensywnym świądem. Zmiany lokalizują się najczęściej w okolicach wyprostnych ciała (łokcie, kolana), a także na karku, ramionach, skórze owłosionej głowy i pośladkach, a niekiedy na śluzówkach jamy ustnej.
- Okołoodbytnicze ropnie, przetoki i szczeliny na rumieniowym tle – współistnieją z chorobą Leśniowskiego-Crohna. W praktyce klinicznej obserwowane są także przypadki torów brodawkowych przypominających kłykciny kończyste.
Źródła: gastroenterologia-praktyczna.pl, podyplomie.pl
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