Person J R, Bernhard J D
J Am Acad Dermatol. 1986 Sep;15(3):559-63. doi: 10.1016/s0190-9622(86)70207-7.
The pustular dermatitis associated with small bowel bypass surgery and the cutaneous manifestations of inflammatory bowel disease are well known and generally assumed to be due to the absorption of microbial antigens from the bowel. Monomeric serum IgA is assumed to originate in the gastrointestinal tract, and circulating IgA immune complexes, as seen in dermatitis herpetiformis, should make us suspicious of a gastrointestinal tract source. These circulating immune complexes and perhaps polyclonal increases in serum IgA may be the result of minor perturbations of mucosal permeability or the failure of locally produced dimeric serum IgA to inactivate bacterial or dietary antigens. Such disparate entities as Reiter's syndrome, psoriasis, pyoderma gangrenosum, and ankylosing spondylitis, as well as the pustular eruptions of Behçet's syndrome, pustular psoriasis, and lithium therapy, may share this common pathogenesis.
与小肠旁路手术相关的脓疱性皮炎以及炎症性肠病的皮肤表现是众所周知的，通常认为是由于肠道微生物抗原的吸收所致。单体血清IgA被认为起源于胃肠道，而在疱疹样皮炎中所见的循环IgA免疫复合物，应使我们怀疑其来源于胃肠道。这些循环免疫复合物以及血清IgA可能的多克隆增加，可能是黏膜通透性轻微改变或局部产生的二聚体血清IgA无法使细菌或饮食抗原失活的结果。诸如赖特综合征、银屑病、坏疽性脓皮病和强直性脊柱炎等不同疾病，以及白塞综合征、脓疱型银屑病和锂治疗引起的脓疱性皮疹，可能都有这种共同的发病机制。
