Mucocutaneous Manifestations of Inflammatory Bowel Disease

Abstract

Inflammatory bowel disease (IBD) is a chronic and incurable disease, of unknown etiology, associated with an unregulated immune response to environmental triggers in a genetically predisposed host. IBD affects mainly the gastrointestinal (GI) tract and includes Crohn's disease (CD) and ulcerative colitis (UC). However, a large percentage of patients may present with extraintestinal manifestations, including mucocutaneous ones (which are the most common) and dermatologic findings, such as erythema nodosum, pyoderma gangrenosum, and aphthous stomatitis (which are the most frequently occurring). According to pathophysiologic mechanisms, mucocutaneous manifestations of IBD are classified into five categories, namely, specific manifestations, associated manifestations, reactive manifestations, adverse effects of IBD therapy, and malabsorption manifestations. Recognizing such manifestations should not be performed only by a dermatologist but also other specialties such as internal medicine, gastroenterology, among others. This is because these manifestations can present before the IBD diagnosis, even in the absence of GI symptoms. Therefore, these skin lesions could be a fundamental tool for the earlier diagnosis of IBD. This review provides a comprehensive overview of the most common cutaneous manifestations of IBD with a focus on their epidemiology, diagnostic criteria, clinical presentation, and available medical treatment.

Mucocutaneous pyoderma gangrenosum: a case report and literature review

“…Mucocutaneous manifestations are the most common extraintestinal manifestations of IBD, appearing in 22 to 75% of patients with Crohn's disease (CD) and 5 to 11% of patients with UC (5). The mucocutaneous manifestations of IBD are classified into five categories according to their pathophysiology: 1) specific, 2) reactive, 3) associated, and 4) malabsorption manifestations, as well as 5) adverse effects of IBD therapy (6). PG is considered a reactive manifestation, and it is the second-most common cutaneous manifestation after erythema nodosum.…”

The Prevalence of extraintestinal manifestations in Inflammatory Bowel Disease

“…During its course, elevation of the legs and bed rest are advised, and nonsteroidal anti-inflammatory drugs are first-line treatment for pain. (23)(24)(25)(26)(27)(28) Abscesses, fistulas, fissures and ulcers are the most common manifestations and contribute significantly to the incidence of CD. In 36% of patients, perianal lesions are observed.…”

“…Oral lesions are observed in 8-9% of patients; these are mainly angular cheilitis, straight and deeply cut lip ulcers, lip and tongue fissures, gingival nodules, cobblestone-like oral mucosa and painful inflammation of the gingiva. (23)(24)(25)(26)(27)(28) Pyoderma gangrenosum is seen in about 1%-2% of patients and is more commonly found in association with ulcerative colitis. It occurs more frequently in women.…”

“…Management consists of antibiotics, systemic steroids, dapsone and sulphapyridine, and restoration of the intestinal structure by operation. (23)(24)(25)(26)(27)(28) Oral stomatitis occurs in about 10% of IBD patients, most commonly in CD, but more frequently in UC. Ulcers may occur as a result of CD expansion with classic granulomatous inflammation or as a result of nutrient deficiencies secondary to malabsorption in the course of IBD.…”

Pyoderma gangrenosum in a patient with onset of inflammatory bowel diseases

“…Дебют ГП может произойти до, во время или после появления симптомов ВЗК и дальнейшее течение этого заболевания может протекать независимо от течения ВЗК. [6,7,8,9,10].…”