Intestinal diseases, skin changes

• Chronic inflammatory bowel disease (IBD), (e.g. enteritis regionalis(Crohn's disease - see also Crohn's disease, skin changes), ulcerative colitis; skin symptoms in approx. 70% of patients):
  • Abscesses, fissures and fistulas
  • Erythema nodosum
  • Recurrent oral aphthae
  • Aggravation of psoriasis vulgaris
  • Lichen planus
  • Pyoderma gangraenosum
  • Pyostomatitis vegetans
  • Bowel bypass syndrome (Bowel-associated dermatosis-arthritis-syndrome)
  • NMSC (Nonmelanoma Skin Cancer; note: accumulation of NMSC due to ongoing immunosuppressive therapies).
  • Cheilitis granulomatosa
  • Sweet syndrome
  • Neutrophilic dermatosis of the back of the hand (minus variant of Sweet syndrome)

  • Aseptic abscess syndrome

• Bleeding from the intestines (from birth or early childhood):
  • Peutz-Jeghers syndrome
  • Teleangiectasia haemorrhagica hereditaria
  • Blue-Rubber-Bleb-Naevus syndrome
  • Ehlers-Danlos syndrome
  • Pseudoxanthoma elasticum
• Bleeding from the intestine (acquired):
  • Kaposi's sarcoma.
• Occlusion of intestinal vessels:
  • Leukocytoclastic vasculitis
  • Collagenoses (e.g. systemic scleroderma, systemic lupus erythematosus, dermatomyositis):
  • M. Behçet
  • Köhlmeier-Degos disease (malignant atrophic papulosis, vasculitic process with multiple infarcts in the gastrointestinal tract)
• Polyposis:
  • Peutz-Jeghers syndrome
  • Cronkhite-Canada syndrome.
• Malabsorption syndromes:
  • Avitaminoses (e.g. beri-beri, pellagra, scurvy, purpura, perleche)
  • Dermatitis herpetiformis Duhring (sprue?)
  • Zinc deficiency dermatoses
  • Acrodermatitis enteropathica.
  • Candidiasis
• Intestinal tumors:
  • Cutaneous paraneoplasia

IL-10 attenuates intestinal inflammation and is a good candidate gene for IBD. Polymorphisms in the IL-10 receptor are also associated with ulcerative colitis, which occurs in early childhood. In addition, severe infantile enterocolitis similar to Crohn's disease is caused by LOF mutations in interleukin-10 and interleukin-10 receptor . The disease is associated with severe perianal abscesses and fistulas. In addition, patients may suffer from recurrent fever and respiratory infections. Cutaneous folliculitis and arthritis also occur in individuals with IL-10 receptor mutations. Hematopoietic stem cell transplantation is currently the only curative therapy.

1. Borelli S (2002) Skin manifestations of diseases of the gastrointestinal tract. Schweiz Rundsch Med Prax 91: 1029-1036
2. Engelhardt KR et al (2014) IL-10 in humans: lessons from the gut, IL-10/IL-10 receptor deficiencies, and IL-10 polymorphisms. Curr Top Microbiol Immunol 380:1-18.
3. Kirsch B et al (1992) Dermatoses in inflammatory bowel disease. Akt Dermatol 18: 17-22
4. Mandraka F et al (2003) Cholestasis and vomiting: unusual differential diagnosis in a case of Peutz-Jeghers syndrome. Dtsch Med Wochenschr 128: 984-988
5. Marks J (1983) Skin diseases and the small intestine. Internist 24: 550-555
6. Pierer M et al (2002) Extra-intestinal manifestations of chronic inflammatory bowel diseases. Z Gastroenterol 40 (Suppl 1): S92-S104
7. Trueb RM (2003) Cutaneous manifestations of internal diseases: purpura, livedo, pyoderma gangrenosum. Schweiz Rundsch Med Prax 92: 1479-1487
8. Ochsendorf F (2020) Manifestations of internal diseases on the skin. Consilium Dermatologie live 2: 24-29.