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Crohn's disease is a chronic granulomatous disorder that may involve any segment of the gastrointestinal tract. Extraintestinal manifestations of Crohn's disease such as erythema nodosum and pyoderma gangrenosum are well recognized and appreciated. However, metastatic Crohn's disease (MCD), defined as the same granulomatous inflammation seen in Crohn's disease but at a skin site distant to the gastrointestinal tract, is less well recognized. We report three cases of MCD involving the perianal and vulvar skin that initially presented with vulvar pain.

To assess the comparative efficacy of energy treatments in resolving cherry angiomata. Design: Rater-blinded randomized controlled trial. Setting: Outpatient dermatology clinic in an urban referral academic medical center. Participants: Fifteen healthy adults aged 21 to 65 years were enrolled. Two eligible individuals who were approached declined to participate, and no one enrolled was withdrawn for adverse effects. Interventions: For each participant, 3 areas on the torso were demarcated such that each area contained 4 cherry angiomata. Each area was then randomly assigned to receive 1 of the 3 treatments: pulsed-dye laser (PDL) (595 nm), potassium titanyl phosphate (KTP) laser (532 nm), or electrodesiccation. Two treatments spaced 2 weeks apart were delivered to each area. Main Outcome Measures: Standardized photographs from before treatment and 3 months after the last treatment were evaluated for color and texture on visual analog scales. Results: Mean change in color was a significant improvement of 7.77 (P Ͻ.001), but there was no significant difference across treatment arms (P = .19). Mean change in texture was a significant improvement of 6.23 (P Ͻ .001), and the degree of textural change also differed across treatments (P Ͻ .001). In pairwise comparisons, cherry angiomata treated with electrodesiccation were significantly less improved than were those receiving KTP laser (P = .003) and those treated with PDL (P =.001). The effects of KTP laser and PDL on texture were not different (P=.50). Conclusions: Cherry angiomata can be effectively treated with electrodesiccation and with laser. Laser, especially PDL, may minimize the likelihood of treatmentassociated textural change.

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