The difference in extraintestinal manifestations of inflammatory bowel disease for children and adults

Abstract

Extraintestinal manifestations (EIMs) are frequently observed in adult and pediatric patients with inflammatory bowel disease (IBD). The most common EIMs involve the joints, skin, and eyes, but they can affect various organs and result in significant morbidity. Since EIMs can appear years before the diagnosis of IBD is made, clinicians should be aware of their various manifestations to help decrease diagnostic delay of IBD and establish appropriate treatment plans.

Dermatological Manifestations in Pediatric Inflammatory Bowel Disease

“…Dermatological manifestations are seen in children with both CD and UC, their incidence varying from 10–15% [ 4 ]. They are either specific or reactivation lesions or may be related to malabsorption or drugs used in the treatment of IBD; a small group of lesions have been described in the literature concomitant to IBD but are considered miscellaneous lesions ( Table 1 ) [ 3 ].…”

“…Usually, it is located on the extensor surfaces of the extremities; in the pediatric population, PG has been reported more often on the legs, followed by the head and the gluteal region. It has been reported in 0.3–5% of patients with IBD [ 4 ]. The authors reported that PG is more common in children with CD than UC, and is related mostly to the colonic involvement, presence of erythema nodosum, and arthritis [ 24 ].…”

“…It manifests with painful erythematous papules, plaques, and nodules located on the arms, limbs, trunk, and face; it is usually associated with the disease level of activity. Sweet’s syndrome has been reported at various ages, including multiple pediatric patients and neonates, but it has been linked mostly to leukemia or connective tissue diseases and only occasionally to IBD [ 4 ]. Kim MJ et al described a case of Sweet’s syndrome on a pediatric patient that had just begun treatment with azathioprine for UC for 10 days [ 33 ].…”

“…In general, extraintestinal manifestations of IBD can be divided into two groups, depending on the pathophysiology. On one hand, there are IBD activity-related lesions, which have a similar immune mechanism (affecting the joints—peripheral and axial arthropathies; involving the skin—erythema nodosum, pyoderma gangrenosum, Sweet’s syndrome, aphthous stomatitis; the eye- episcleritis or uveitis) [ 4 , 5 ].…”

“…Cutaneous manifestations in patients with IBD are usually either specific lesions, reactivation lesions, manifestations related to nutritional malabsorption, or therapeutic regime, or they can be miscellaneous lesions [ 4 , 5 ]. Their diagnosis is based on the clinical characteristic features and on the exclusion of other dermatological disorders.…”