The gut and the skin LIONEL FRY

A CONSIDERABLE amount of work has been carried out on the relationship between the small intestine and the skin in various disorders during the past decade and this article will be concerned with the small intestine rather than the whole of the alimentary tract. The exact relationship between the small intestine and skin disease has posed many problems in the past and how one organ may influence the other is still unknown in the majority of instances. Methods for investigating the small intestine have improved during the last few years particularly with the advent of per-oral small intestinal biopsy. When a patient has 'disorders' both of the small intestine and skin it is important that the 'primary' disease is established and appropriate treatment given and for this purpose it has to be appreciated which investigations for the small intestine should be performed, and what are the limitations of these investigations, in association with skin disease. At the present time the association of small intestine and skin disease may be considered under the following subgroups. 1. A non-specific relationship in which: (a) primary disease of the small intestine causes nonspecific changes in the skin, (b) primary disease of the skin produces non-specific changes in the small intestine. 2. A specific relationship. A particular diseaseentity of the skin is associated with a particular disorder of the small intestine. 3. A generalized disease process which affects both the skin and the gut but which is not necessarily confined to these two organs, e.g. systemic sclerosis