Metastatic Crohn’s Disease: An Approach to an Uncommon but Important Cutaneous Disorder

Abstract

Objective. To provide physicians with a clinical approach to metastatic Crohn's disease (MCD). Main Message. Metastatic Crohn's disease, defined as skin lesions present in areas noncontiguous with the gastrointestinal tract, is the rarest cutaneous manifestation of Crohn's disease. MCD lesions vary in morphology and can arise anywhere on the skin. MCD presents equally in both sexes and across age groups. Cutaneous findings may precede, develop concurrently with, or follow gastrointestinal involvement. A detailed history and thorough physical examination including a full-skin exam may help to exclude other dermatoses, as MCD can mimic other common disorders. A biopsy is required for a definitive diagnosis. Treatment options for MCD remain underwhelming due to the lack of randomized control studies and varying responses of reported therapeutic methods. Topical, intralesional, and systemic corticosteroids, antibiotics, traditional immunosuppressants, and surgery have shown mixed results. Recently, biologics have shown promise, even with refractory cases of MCD. Conclusion. MCD is an important cutaneous manifestation of this inflammatory disorder. Although a rare entity, early recognition can provide opportunity for successful therapeutic intervention.

Cutaneous manifestations of metastatic Crohn's disease

“…Cutaneous CD affects male and female individuals of all ages . It has been reported that 22%‐44% of patients with CD have cutaneous symptoms at some point in their disease course, and 7%‐24% of children have extraintestinal manifestations of CD . It is likely that the true incidence of cutaneous CD, and specifically MCD, is underestimated because of lack of reporting and misdiagnosis.…”

“…The most common presentation of MCD is genital swelling . Other areas of involvement include the extremities, intertriginous zones, legs, and trunk, with the breast, nipple, ear, and umbilicus reported less often . Some lesions have been reported to be completely asymptomatic, whereas others are pruritic, tender, and painful.…”

“…MCD can precede, occur concurrently with, or follow gastrointestinal symptoms . Several cohorts of cases have shown that MCD appears to occur at the same time as diagnosis of pediatric cutaneous CD in approximately half of cases .…”

“…A 1997 review of 14 cases showed that two‐thirds of the children had genital involvement at presentation and that 11 had cutaneous manifestations before intestinal disease . There is no correlation between severity of gastrointestinal disease and MCD, but cutaneous findings tend to occur more frequently with large bowel disease …”

“…Crohn's disease (CD) is an inflammatory bowel disease that Dr. Crohn first recognized and described in 1932 . Many cutaneous manifestations of CD have been recognized, including the rare presentation of metastatic CD (MCD), which Parks and colleagues first described in 1965 and Mountain and colleagues officially named “metastatic Crohn's disease” in 1970 . In some cases, the skin findings can precede the gastrointestinal symptoms, which occurs more frequently in children than adults; 25%‐30% of patients with CD present when they are younger than 20, and approximately 2% of patients present when they are younger than 10 .…”