Small-intestinal mucosal abnormalities in various skin diseases fact or fancy?

Abstract

SUMMARY Two-thirds of patients with dermatitis herpetiformis have been found to have a flat or convoluted mucosa but no special association has been found in the other dermatoses studied with structural alterations in the small bowel mucosa. The frequency distribution of the predominant and individual small intestinal mucosal features is the same in the patients in the present series with eczema, psoriasis, and rosacea as in the local control population. Apredominantly convoluted mucosa has been found in the upper small intestine in 8 %of these patients and in 8 % of subjects without a rash. The presence of convolutions in patients with these dermatoses is merely a reflection of the incidence in the normal population of Newcastle upon Tyne. Different findings in the same skin disease in different parts of the country are explicable on the basis of variations in the nornmal mucosa between one geographical region and another.The increased incidence of a convoluted mucosa in the north east of England requires further study to determine whether it is indicative of an increased incidence of the coeliac syndrome in the region, or whether it results from a minor population difference or a local peculiarity of diet.

Peroral Jejunal Mucosal Biopsy in Dermatological and Some Non-Diarrhoeal Diseases

“…This endemicity of abnormalities of the ai-chitecture of the mucosa in South Indian subjects is noteworthy. Indeed, Marks and Shuster (1970) found that significant variation in the normal jejuual mucosal architecture could be observed from place to ])]ace witliin Great Britain itself, and that findings of controls of Newcastle could vary from that of controls from London or Edinburgh. The works of Holmes et al and Baker et al have further clearly shown that one can get apparently normal villi at light microscopy even from leaf or convoluted villi if the section is cut along the short diameter.…”

Serum Lipids in Patients with Psoriasis

“…[1] described a decrease in small bowel surface area in patients with psoriasis. Abnormalities in the mucosal architecture of the small bowel, in psoriasis, were described by Marks and Shuster [6]. Whether these anatomical changes also have functional implications, leading to mal absorption, remains unknown.…”

Small intestinal mucosal abnormalities in relatives of patients with dermatitis herpetiformis

“…The diagnosis was based on the clinical and histological appearance of the rash and on the response of the rash to treatment with dapsone. There was no selection on the basis of intestinal symptoms but routine investigations for the coeliac syndrome had been done (Marks et al, 1966;Shuster et al, 1968;Shuster and Marks, 1970). Nine propositi had been found to have a flat upper small intestinal mucosa, 10 a predominantly convoluted mucosa, and eight a predominance of leaf or finger-shaped villi.…”

“…The relatives in whom these tests were done were selected purely on the basis of their willingness to take part in the investigation. In view of the difference in the incidence of a convoluted mucosa in apparently normal people from different parts of the world (Baker, Ignatius, Mathan, Vaish, and Chacko, 1962;Banwell, Hutt, andTunnicliffe, 1964;England and O'Brien, 1966;Parkins, Eidelman, Perrin, and Rubin, 1966;Burhol and Myren, 1968) and indeed from different parts of Great Britain (Scott, Williams, and Clark, 1964;Salem and Truelove, 1965;Girdwood, Williams, McManus, Dellipiani, Delamore, and Kershaw, 1966;Marks and Shuster, 1970) the stereomicroscopic appearances in the relatives of the patients with dermatitis herpetiformis were compared with those in a control population from Newcastle upon Tyne (Marks and Shuster, 1970). This consisted of a series of coroner's necropsies on 48 people who died suddenly and in whom the incidence of a predominantly convoluted mucosa proved to be 8% (4/48).…”