Occurrence of inflammatory bowel disease in patients with chronic inflammatory skin diseases: a cohort study

Abstract

Background Several studies have linked various chronic inflammatory skin diseases (CISDs) with inflammatory bowel disease (IBD) in a range of data sources with mixed conclusions. Objectives We compared the incidence of IBDulcerative colitis (UC) and Crohn disease (CD)in patients with a CISD vs. similar persons without a CISD. Methods In this cohort study using nationwide, longitudinal, commercial insurance claims data from the USA, we identified adults and children who were seen by a dermatologist between 2004 and 2020, and diagnosed with either psoriasis, atopic dermatitis, alopecia areata, vitiligo or hidradenitis suppurativa. Comparator patients were identified through risk-set sampling; they were eligible if they were seen by a dermatologist at least twice and not diagnosed with a CISD. Patient follow-up lasted until either IBD diagnosis, death, disenrolment or end of data stream, whichever came first. IBD events, UC or CD, were identified via validated algorithms: hospitalization or diagnosis with endoscopic confirmation. Incidence rates were computed before and after adjustment via propensity-score decile stratification to account for IBD risk factors. Hazard ratios (HR) and 95% confidence intervals (CIs) were estimated to compare the incidence of IBD in CISD vs. non-CISD. Results We identified patients with atopic dermatitis (n = 123 614), psoriasis (n = 83 049), alopecia areata (n = 18 135), vitiligo (n = 9003) or hidradenitis suppurativa (n = 6806), and comparator patients without a CISD (n = 2 376 120). During a median follow-up time of 718 days, and after applying propensity-score adjustment for IBD risk factors, we observed increased risk of both UC (HR UC 2Á30, 95% CI 1Á61-3Á28) and CD (HR CD 2Á70, 1Á69-4Á32) in patients with hidradenitis suppurativa, an increased risk of CD (HR CD 1Á23, 1Á03-1Á46) but not UC (HR UC 1Á01, 0Á89-1Á14) in psoriasis, and no increased risk of IBD in atopic dermatitis (HR UC 1Á02, 0Á92-1Á12; HR CD 1Á08, 0Á94-1Á23), alopecia areata (HR UC 1Á18, 0Á89-1Á56; HR CD 1Á26, 0Á86-1Á86) or vitiligo (HR UC 1Á14, 0Á77-1Á68; HR CD 1Á45, 0Á87-2Á41).Conclusions IBD was increased in patients with hidradenitis suppurativa. CD alone was increased in patients with psoriasis. Neither UC nor CD was increased in patients with atopic dermatitis, alopecia areata or vitiligo.

Phytotherapeuthics Affecting the IL-1/IL-17/G-CSF Axis: A Complementary Treatment Option for Hidradenitis Suppurativa?

“…The worldwide prevalence of HS is estimated at about 1% [ 1 ]. HS is associated with numerous comorbidities including metabolic syndrome, spondyloarthritis, inflammatory bowel disease as well as non-alcoholic fatty liver disease (NAFLD), and is therefore seen as a systemic disease [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Importantly, the number of concomitant diseases correlates with the duration from manifestation of first symptoms until HS diagnosis [ 12 ].…”

Sexual Dysfunction in Female Patients with Inflammatory Bowel Disease: An Overview

“…In a recent nationwide cohort study, HS was significantly associated with an increased risk of CD (HR CD =1.23; 1.03-1.46) but not UC (HR UC =1.01; 0.89-1.14). 53 Given the significant comorbidity associated with this condition, it is unsurprising that a recent systematic review of 12 epidemiological studies noted that sexual dysfunction was significantly increased in HS patients. 54 Vulvovaginal Side-Effects of IBD Specific Therapy Immunosuppressive therapy with azathioprine, 6-mercaptopurine, and anti-TNF biologics have been linked to an increase in certain infections, which in turn can lead to vulvovaginal lesions.…”

“…In a recent nationwide cohort study, HS was significantly associated with an increased risk of CD (HR CD =1.23; 1.03–1.46) but not UC (HR UC =1.01; 0.89–1.14). 53 Given the significant comorbidity associated with this condition, it is unsurprising that a recent systematic review of 12 epidemiological studies noted that sexual dysfunction was significantly increased in HS patients. 54…”

Prevalence of Crohn Disease Among Pediatric Patients With Hidradenitis Suppurativa

“…Hidradenitis suppurativa (HS) and Crohn disease (CD) are chronic, recurrent, inflammatory disorders with shared genetic susceptibility and immunologic features. Population-based studies have found an association between CD and HS in adults; however, this association is poorly characterized among pediatric patients. Herein we compared the prevalence of CD among pediatric patients with and without HS.…”