Dermatological Manifestations in Inflammatory Bowel Diseases

Abstract

Inflammatory bowel diseases (IBDs) may be associated with extra-intestinal manifestations. Among these, mucocutaneous manifestations are relatively frequent, often difficult to diagnose and treat, and may complicate the course of the underlying disease. In the present review, a summary of the most relevant literature on the dermatologic manifestations occurring in patients with inflammatory bowel diseases has been reviewed. The following dermatological manifestations associated with IBDs have been identified: (i) specific manifestations with the same histological features of the underlying IBD (occurring only in Crohn’s disease); (ii) cutaneous disorders associated with IBDs (such as aphthous stomatitis, erythema nodosum, psoriasis, epidermolysis bullosa acquisita); (iii) reactive mucocutaneous manifestations of IBDs (such as pyoderma gangrenosum, Sweet’s syndrome, bowel-associated dermatosis-arthritis syndrome, aseptic abscess ulcers, pyodermatitis–pyostomatitis vegetans, etc.); (iv) mucocutaneous conditions secondary to treatment (including injection site reactions, infusion reactions, paradoxical reactions, eczematous and psoriasis-like reactions, cutaneous infections, and cutaneous malignancies); (v) manifestations due to nutritional malabsorption (such as stomatitis, glossitis, angular cheilitis, pellagra, scurvy, purpura, acrodermatitis enteropathica, phrynoderma, seborrheic-type dermatitis, hair and nail abnormalities). An accurate dermatological examination is essential in all IBD patients, especially in candidates to biologic therapies, in whom drug-induced cutaneous reactions may assume marked clinical relevance.

Mucocutaneous Manifestations of Inflammatory Bowel Disease

“…The most common extraintestinal manifestations are mucocutaneous ones, present in up to 22%-75% of patients with CD and 5%-11% of UC patients [ 6 ], followed by musculoskeletal ones, eye disease, hepatobiliary disease, and endocrine disease [ 7 ]. The most common mucocutaneous manifestations are erythema nodosum, pyoderma gangrenosum, and aphthous stomatitis [ 8 ]. According to pathologic mechanisms, IBD’s mucocutaneous manifestations are classified into five categories (Table 2 ).…”

“…Specific mucocutaneous manifestations represent an extension of the GI inflammatory process, sharing the same histologic findings [ 5 ], including non-caseating granulomas, dermic infiltrates with giant multinucleated cells, lymphocytes, and eosinophils [ 4 ]. These are found only in CD, as UC does not extend to external mucosa [ 8 ].…”

“…Perianal lesions are observed in 36% of patients [ 4 , 11 ]. It may present as erythema, fissure, perianal stenosis, fecal incontinence, abscess, and fistulae (these two being more frequent); such lesions may also be observed in a peristomal region and abdominal scars due to laparotomy or umbilical ones creating enterocutaneous fistulae [ 4 , 8 ]. Specific oral lesions are found in 8%-9% of patients; these present primarily as angular cheilitis, linear and deep lip ulcers, lip and tongue fissures, gingival nodules, cobblestone-like oral mucosa, and painful gingivitis [ 4 , 11 ].…”

“…Clinically, plaques, nodules, ulcers, abscesses, and fistulae may be observed [ 11 ]. Major differential diagnoses are erysipelas, cellulitis, and hidradenitis suppurativa [ 8 ]. The severity of metastatic lesions is not related to the degree of inflammation of intestinal disease [ 11 ] and responds slower to treatment than GI tract lesions [ 9 ].…”

“…A theory is a cross-reaction antigenicity between the skin and intestinal mucosa [ 11 ]. These lesions are present in both CD and UC [ 8 ] and include pyoderma gangrenosum (PG), pyodermatitis-pyostomatitis vegetans (PDPSV), Sweet's syndrome, bowel-associated dermatosis-arthritis syndrome (BADAS). Less frequently, the synovitis, acne, pustulosis, hyperostosis, osteitis syndrome (SAPHO) and the pyogenic arthritis, pyoderma gangrenosum, and acne syndrome (PAPA) are included [ 8 ].…”