臨牀消化器内科 Vol.28 No.5(2-1)


特集名 IBDと合併症
題名 腸管外合併症 (1) 皮膚科疾患―結節性紅斑,壊疽性膿皮症など
発刊年月 2013年 05月
著者 三井 浩 聖マリアンナ医科大学病院皮膚科
【 要旨 】 炎症性腸疾患(IBD)はさまざまな腸管外合併症を伴う.なかでも皮膚粘膜疾患は頻度が高く,共通した病態により発症すると考えられており,近年ではTh17が注目されている.分類として特異的皮膚病変,反応性皮膚病変,栄養障害などから生じる二次的なものなどがある.反応性皮膚病変である結節性紅斑,壊疽性膿皮症はとくに頻度が高い.結節性紅斑は下腿伸側に好発する有痛性紅色結節として認め,本態は皮下脂肪織炎である.壊疽性膿皮症は慢性再発性の有痛性穿掘性潰瘍であり,感染症などの除外診断が重要である.これら皮膚病変のなかにはIBDの病勢に並行するものもあり,日常診療の場において注意深い観察が必要である.
Theme Complication of Inflammatory Bowel Disease
Title Skin Manifestations of Inflammatory Bowel Disease
Author Hiroshi Mitsui Department of Dermatology, St. Marianna University School of Medicine
[ Summary ] Inflammatory bowel disease (IBD) is an idiopathic inflammatory disease of the intestinal tract. Patients with IBD may have complications due to extraintestinal manifestations. The skin is one of the most commonly affected organ systems in patients with IBD. The pathogenesis of cutaneous manifestation of IBD is due to common mechanisms involving the bowel and skin. Disrupted equilibrium between host defense and tolerance, as well as subsequent abnormal immune reactions may be responsible for cutaneous disorders in patients with IBD. Studies have implicated several possible immune pathways concerning cutaneous IBD disorders. Recent studies suggest that Th17 may play an important role in the pathogenesis of IBD and other autoimmune disease as well. The cutaneous manifestations of IBD have been classified into four categories related to pathogenesis, specific cutaneous manifestations, reactive cutaneous manifestations and secondary manifestations due to complications of IBD. Erythema nodosum and pyoderma gangrenosum are the most common skin lesions associated with IBD. Since skin disorders may be correlated with IBD activity, it is important to understand that skin manifestations should always be checked and evaluated for patients with IBD.
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