Dermatological Manifestations in Pediatric Inflammatory Bowel Disease

Abstract

Background and Objectives: Over the last years, inflammatory bowel disease (IBD) has been reported on a high incidence in pediatric populations and has been associated with numerous extraintestinal manifestations, making its management a real challenge for the pediatric gastroenterologist. Dermatological manifestations in IBD are either specific, related to the disease activity or treatment-associated, or non-specific. This literature review aims to identify and report the dermatological manifestations of IBD in children, the correlation between their appearance and the demographical characteristics, the relationship between these lesions and disease activity, and to highlight the impact of dermatological manifestations on an IBD treatment regime. Materials and Methods: A systemic literature review was performed, investigating articles and case reports on dermatological manifestations in children with IBD starting from 2005. A total of 159 potentially suitable articles were identified and after the exclusion process, 75 articles were selected. Results: The most common dermatological manifestations reported in pediatric IBD are erythema nodosum and pyoderma gangrenosum. More rare cases of metastatic Crohn’s disease, epidermolysis bullosa acquisita, small-vessel vasculitis, necrotizing vasculitis, leukocytoclastic vasculitis, cutaneous polyarteritis nodosa, and Sweet’s syndrome have been reported. Oral manifestations of IBD are divided into specific (tag-like lesions, mucogingivitis, lip swelling with vertical fissures, aphthous stomatitis, and pyostomatitis vegetans) and non-specific. IBD treatment may present with side effects involving the skin and mucosa. Anti-tumor necrosis factor agents have been linked to opportunistic skin infections, psoriasiform lesions, and a potentially increased risk for skin cancer. Cutaneous manifestations such as acrodermatitis enteropathica, purpuric lesions, and angular cheilitis may appear secondary to malnutrition and/or malabsorption. Conclusions: The correct diagnosis of dermatological manifestations in pediatric IBD is of paramount importance because of their impact on disease activity, treatment options, and a patient’s psychological status.

Persistent oral mucosal changes in a 7‐year‐old boy

“…[4][5][6][7] Oral manifestations of Crohn's disease can be divided into two categories: specific and nonspecific manifestations. 8 Nonspecific oral manifestations include aphthae, cheilitis angularis, lip fissures, fistulas, and gingival hyperplasia, which can occur in a variety of diseases. Specific oral manifestations include ulceration of the buccal sulcus, mucosal pseudopolyps (mucosal tags), edema of the inner cheek with a cobblestone-like impression, pyostomatitis vegetans, and hypertrophy of the lips within the context of orofacial granulomatosis.…”

Persistierende Mundschleimhautveränderungen bei einem 7‐jährigen Jungen

“…[4][5][6][7] Orale Manifestationen des Morbus Crohn können in spezifische und unspezifische eingeteilt werden. 8 Zu den unspezifischen oralen Manifestationen gehören Aphthen, Cheilitis angularis, Lippenfissuren, Fisteln sowie die Gingivahyperplasie, die bei diversen Erkrankungen vorkommen können. Andere Schleimhauterscheinungen, wie Ulzerationen des bukkalen Sulcus, die Schleimhaut-Pseudopolypen (mucosal tags), ein Ödem an der Wangeninnenseite mit pflastersteinartigem Relief (cobblestoning), die Pyostomatitis vegetans sowie die Hypertrophie der Lippen im Rahmen einer orofazialen Granulomatose gehören zu den spezifischen oralen Manifestationen.…”

Dermatologic manifestations in pediatric patients with inflammatory bowel disease

“…1 There is a strong association of IBD in patients of all ages with extraintestinal manifestations. 2,3 While dermatologic conditions are well characterized in adults with IBD, 2,4 there is a paucity of data in the pediatric population. 4 Overall, the incidence of dermatologic conditions in children with IBD has been estimated at between 10% and 15%.…”

“…2,3 While dermatologic conditions are well characterized in adults with IBD, 2,4 there is a paucity of data in the pediatric population. 4 Overall, the incidence of dermatologic conditions in children with IBD has been estimated at between 10% and 15%. 2 Previous studies in pediatric populations with IBD have been conducted based on the presence of IBD-specific and IBD-nonspecific dermatologic manifestations.…”