Passarini Beatrice, Infusino Salvatore Domenico, Barbieri Elena, Varotti Elisa, Gionchetti Paolo, Rizzello Fernando, Morselli Claudia, Tambasco Rosy, Campieri Massimo
Department of Specialistic and Experimental Clinical Medicine, Division of Dermatology, University Hospital of Bologna, Bologna, Italy.
Dermatology. 2007;215(4):295-300. doi: 10.1159/000107622.
Ulcerous rectocolitis and Crohn's disease are the best known forms of inflammatory bowel disease (IBD). Skin manifestations are not uncommon in IBD and may be divided into specific cutaneous signs, aspecific cutaneous signs, and cutaneous signs caused by drugs used for IBD therapy. The specific signs (fistulas, rhagades and ulcers) are the result of the diffusion of the intestinal inflammatory process into the skin. Aspecific cutaneous signs (stomatic aphthosis, erythema nodosum, pyoderma gangrenosum, Sweet's syndrome, vasculitis, bullous diseases) are quite frequently found in those suffering from IBD, but also in apparently healthy subjects, and may sometimes be the first sign of the intestinal disease. Cutaneous manifestations due to drugs vary in clinical aspect and are the direct consequence of the therapies adopted, which in IBD patients can be quite numerous: steroids, immunosuppressants, 5-aminosalicylic acid, biological agents, antibiotics.
Due to the frequent finding of cutaneous manifestations in patients affected by IBD, a collaboration was set up between the Dermatological Clinic of the University of Bologna and the Center for the Study of IBD of the same university hospital. The aim was to diagnose the cutaneous signs appearing during IBD and to establish their etiopathogenesis in order to assess whether they were the result of epiphenomena of the IBD or side effects of the therapies adopted.
The cutaneous manifestations we observed can be divided into three distinct groups: signs that were specific to the basic disease, aspecific signs and finally signs attributable to the drugs used for therapy. Particular attention was given to the aspecific signs and those consequential to therapy. The aspecific cutaneous signs seen in our clinic generally reflect those reported in the literature. The cutaneous manifestations due to drugs were further divided into three groups: rosacea, acneiform dermatitis and psoriasis-like dermatitis. The most notable aspect of our series is the high number of patients presenting psoriasiform-type dermatitides with a generally widespread diffusion.
We would like to draw attention to the fact that all patients with psoriasis had been undergoing treatment with drugs inhibiting tumor necrosis factor alpha (TNF-alpha) as part of IBD therapy. In all cases, the cutaneous reaction started after the third or fourth infusion of the biological drug. Anti-TNF-alpha agents have also been successfully used to treat psoriasis in the last few years. The reason for this apparently paradoxical effect of the therapy is still unclear.
溃疡性直肠结肠炎和克罗恩病是最常见的炎症性肠病（IBD）形式。皮肤表现在IBD中并不罕见，可分为特异性皮肤体征、非特异性皮肤体征以及IBD治疗所用药物引起的皮肤体征。特异性体征（瘘管、皲裂和溃疡）是肠道炎症过程扩散至皮肤的结果。非特异性皮肤体征（口腔阿弗他溃疡、结节性红斑、坏疽性脓皮病、Sweet综合征、血管炎、大疱性疾病）在IBD患者中很常见，但在看似健康的个体中也会出现，有时可能是肠道疾病的首发体征。药物引起的皮肤表现临床情况各异，是所采用治疗方法的直接后果，IBD患者可能会使用多种药物：类固醇、免疫抑制剂、5-氨基水杨酸、生物制剂、抗生素。
由于IBD患者中皮肤表现较为常见，博洛尼亚大学皮肤科诊所与同一大学医院的IBD研究中心开展了合作。目的是诊断IBD期间出现的皮肤体征，并确定其病因发病机制，以评估这些体征是IBD的附带现象还是所采用治疗方法的副作用。
我们观察到的皮肤表现可分为三个不同的组：基础疾病特有的体征、非特异性体征以及最终归因于治疗所用药物的体征。特别关注了非特异性体征和治疗相关的体征。我们诊所中观察到的非特异性皮肤体征通常与文献报道的相符。药物引起的皮肤表现进一步分为三组：酒渣鼻、痤疮样皮炎和银屑病样皮炎。我们系列研究中最显著的方面是出现银屑病样皮炎的患者数量众多，且通常广泛分布。
我们想提请注意，所有银屑病患者都在接受抑制肿瘤坏死因子α（TNF-α）的药物治疗，作为IBD治疗的一部分。在所有病例中，皮肤反应在第三次或第四次输注生物药物后开始。在过去几年中，抗TNF-α药物也已成功用于治疗银屑病。这种治疗明显矛盾效果的原因仍不清楚。
