Cutaneous Manifestations in Patients With Inflammatory Bowel Diseases

Abstract

The skin is one of the most common extraintestinal organ system affected in patients with inflammatory bowel disease (IBD), including both Crohn's disease and ulcerative colitis. The skin manifestations associated with IBD are polymorphic and can be classified into 4 categories according to their pathophysiology: (1) specific, (2) reactive, (3) associated, and (4) induced by IBD treatment. Cutaneous manifestations are regarded as specific if they share with IBD the same granulomatous histopathological pattern: perianal or metastatic Crohn's disease (commonly presenting with abscesses, fistulas or hidradenitis suppurativa-like features) is the prototype of this setting. Reactive cutaneous manifestations are different from IBD in the histopathology but have close physiopathological links: pyoderma gangrenosum, a neutrophil-mediated autoinflammatory skin disease typically manifesting as painful ulcers, is the paradigm of this group. Among the cutaneous diseases associated with IBD, the most commonly seen are erythema nodosum, a form of panniculitis most commonly involving bilateral pretibial areas, and psoriasis, a T helper 1/T helper 17-mediated erythematous squamous inflammatory disease. Finally, the number of cutaneous adverse reactions because of IBD therapies is progressively increasing. The most frequent drug-induced cutaneous manifestations are psoriasis-like, eczema-like, and lichenoid eruptions, as well as cutaneous lupus erythematosus for biologics, and nonmelanoma skin cancer, mainly basal cell and squamous cell carcinomas for thiopurines.

Metastatic Crohn’s disease in pediatrics

“…There is no consensus document for the treatment of MCD. Treatment depends on the clinical condition of the patient, severity and extent of disease because many options have been tried (6,8): topical, intralesional or systemic steroids, metronidazole, dapsone, tetracycline, azathioprine, 6-mercaptopurine, sulfasalazine, tacrolimus (5), cyclosporine and infliximab (14,15). The two girls in our series were quite similar according to management and further development.…”

Cutaneous Adverse Reactions during Anti-Tnf Alpha Treatment for Inflammatory Bowel Diseases: The Experience of the Dermatology Clinic of Cagliari

“…Dermatologist's consultation is important to suggest preventive measures, collect precise anamnestic information and recognize minimal skin findings, especially before the biologic treatment is administered to avoid eventual over-esteem of drug responsibility. Minimal skin disorders observed at the screening visits were excluded from the study, representing specific and non-specific findings related to the chronic immune activation and saline/ nutritional depletion of active inflammatory bowel diseases, as well as other immunosuppressive therapy side effects [41][42][43][44]. In our biologic "naïve" patients, history of herpes infections, steroidal acne and diffuse folliculitis, striae distensae, skin fragility with capillarity, and one case of leucocytoclasic vasculits were recorded and excluded from the study if further presenting under biologic treatment in that patient.…”

“…None of our patients required more invasive investigations, such as surgical excision and histological examination. Besides, melanoma occurrence seems to be correlated with the duration of anti-TNF administration, with a suggested meantime of 47.6 months from treatment beginning [43]. Long-term follow-up and patient education about skin pigmentary lesions changes are necessary to avoid any delay in diagnosis.…”

Pioderma Gangrenoso em Doente com Colite Ulcerosa

“…O pioderma gangrenoso é uma dermatose neutrofílica incomum, de curso crónico-recidivante, cuja etiopatogenia é provavelmente multifactorial. [1][2][3] Surge frequentemente (50% -70%) associado a doenças sistémicas, 1-3 nomeadamente doenças inflamatórias intestinais, 4,5 artrites e neoplasias hematológicas. O diagnóstico precoce é fundamental e implica reconhecer as manifestações clínicas sugestivas, excluir outras causas de ulceração e pesquisar eventuais associações.…”