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Z Gastroenterol 2001; 39(2): 137-144
DOI: 10.1055/s-2001-11153
Originalarbeit
© Karl Demeter Verlag im Georg Thieme Verlag Stuttgart · New York

Cutaneous manifestations in inflammatory bowel disease[]*

A. Tromm1 , D. May2 , E. Almus2 , E. Voigt2 , I. Greving3 , U. Schwegler4 , Th Griga2
  • Klinik für Innere Medizin, Evangelisches Krankenhaus Hattingen GmbH, Akademisches Lehrkrankenhaus der Ruhr-Universität Bochum
  • , Abt. für Gastroenterologie und Hepatologie, BG-Kliniken Bergmannsheil, Klinikum der Ruhr-Universität Bochum
  • , Abt. für Innere Medizin, Elisabeth-Krankenhaus Recklinghausen
  • , Abt. für Innere Medizin, Martin-Luther-Krankenhaus Bochum-Wattenscheid
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Publication History

3.7.2000

31.8.2000

Publication Date:
31 December 2001 (online)

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Summary

Numerous extraintestinal manifestations in various organ systems have been reported to be associated with inflammatory bowel disease (IBD). Aim of the present paper was to evaluate the frequency of cutaneous manifestations in Crohn’s disease (CD) and ulcerative colitis (UC) with respect to their location, the activity and location of the underlying disease, the treatment options and the time to remission.

Methods: The medical records of 1043 inpatients with CD and UC were screened retrospectively for extraintestinal symptoms with special regard to cutaneous manifestations.

Results: The prevalence of cutaneous manifestations in IBD was 22/1043 (2.1 %; 18 women, 4 men; age: 31.41 ± 9.9 [21 51] yrs.). In 15/22 patients (68.2 %) the cutaneous manifestations were associated with CD, in 7/22 patients (31.8 %) UC was confirmed. In 6/22 patients (27.3 %) pyoderma gangrenosum (PG) was diagnosed, in 16/22 patients (72.7 %) erythema nodosum (EN). EN and PG predominately occurred at the lower legs: In 68.1 % the tibia was the main affection site. Other locations like breast or anus were rare. In 16/22 patients (72.7 %) an acute phase of the underlying disease was evident, in 6/22 patients (27.3 %) CD or UC were in remission. In patients with CD a colonic involvement was found in 86.7 %. Arthritis was the most frequent coexisting extraintestinal manifestation in CD (53.3 %) and UC (28.8 %). Drug treatment was performed with high doses of glucocorticoids and salicylates. The time to remission in patients with EN was significantly shorter as compared to PG (5.3 ± 1.8 vs. 19.6 ± 14.2 weeks; p < 0.001). In 5/22 patients (22.7 %) cutaneous manifestations reoccurred after a symptom-free interval. All efflorescenses reoccurred during an active phase of the underlying disease at the same manifestation site as the initial presentation.

Conclusion: In this series the prevalence of cutaneous manifestations in IBD was 22/1043 (2.1 %). EN and PG were more frequent in women with IBD, in CD, and during the acute phases of the underlying disease. EN and PG predominately affect the lower legs. Cutaneous manifestations respond well to an acute phase therapy of the underlying disease. The time to remission was significantly shorter in EN as compared to PG. However, relapses have to be considered in a relevant subgroup of patients.

Hautveränderungen bei chronisch-entzündlichen Darmerkrankungen

Zahlreiche extraintestinale Manifestationen in unterschiedlichen Organsystemen sind bei chronisch-entzündlichen Darmerkrankungen (CED) beschrieben worden. Ziel der vorliegenden Arbeit war es, die Häufigkeit kutaner Manifestationen bei Morbus Crohn (MC) und Colitis ulcerosa (CU) unter besonderer Berücksichtigung der Lokalisation, der Aktivität und Lokalisation der Grunderkrankung, der Behandlungsregime und der Zeit bis zur Remission zu untersuchen.

Methoden: Die Krankenakten von 1043 stationären Patienten mit MC und CU wurden hinsichtlich extraintestinaler Manifestationen im Bereich der Haut retrospektiv ausgewertet.

Ergebnisse: Die Häufigkeit kutaner Manifestationen bei CED betrug 22/1043 (2,1 %; 18 Frauen, 4 Männer; Alter: 31,41 ± 9,0 [21 51] Jahre). Bei 15/22 Patienten (68,2 %) lag ein MC vor, bei 7/22 Patienten (31,8 %) eine CU. Bei 6/22 Patienten (27,3 %) wurde ein Pyoderma gangrenosum (PG) diagnostiziert, bei 16/22 Patienten (72,7 %) ein Erythema nodosum (EN). EN und PG traten bevorzugt an den unteren Extremitäten auf: Bei 68,1 % war die Tibia die Prädilektionsstelle. Andere Manifestationsorte wie Brust oder Anus waren selten. Bei 16/22 (72,7 %) der Patienten (27,3 %) waren MC oder CU in Remission. Bei Patienten mit MC wurde in 86,7 % eine Kolonbeteiligung festgestellt. Arthritiden waren mit 53,3 % (MC) bzw. 28,8 % (CU) das häufigste gleichzeitig auftretende extraintestinale Symptom. Die medikamentöse Therapie wurde mit hohen Steroiddosen und Aminosalizyten durchgeführt. Die Zeit bis zum Abheilen der Effloreszenzen war bei EN signifikant kürzer als bei PG (5,3 ± 1,8 vs. 19,6 ± 14,2 Wochen; p < 0,001). Bei 5/22 Patienten (22,7 %) kam es zu einem Rezidiv der Hautsymptome nach einem symptomfreien Intervall. Alle Rezidive traten während akuter Krankheitsphasen und an den Stellen der Primäreffloreszenz auf.

Folgerung: PG und EN sind seltene extraintestinale Symptome bei CED, die mehrheitlich während akuter Krankheitsphasen auftreten. Meist sind Frauen und Patienten mit MC betroffen. EN und PG treten bevorzugt an den unteren Extremitäten auf und sprechen recht gut auf die Akute-Phase-Therapie der Grunderkrankung an. Die Abheilungszeiten sind bei Patienten mit EN signifikant kürzer als bei PG. Rezidive müssen jedoch berücksichtigt werden.

Key words

Erythema Nodosum - Pyoderma Gangrenosum - Crohn’s Disease - Ulcerative Colitis

Schlüsselwörter

Erythema nodosum - Pyoderma gangränosum - Morbus Crohn - Colitis ulcerosa

1 Dedicated to Prof. Dr. B. May (Bochum) on occasion of his 65th birthday

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1 Dedicated to Prof. Dr. B. May (Bochum) on occasion of his 65th birthday

Address for correspondence

Priv.-Doz. Dr. med. Andreas Tromm

Klinik für Innere Medizin Evangelisches Krankenhaus Hattingen Akademisches Lehrkrankenhaus der RUB

Bredenscheider Straße 54

45525 Hattingen

Email: Andreas.Tromm@ruhr-uni-bochum.de