Skin complications associated with inflammatory bowel disease

Abstract

Summary Cutaneous manifestations are well‐recognized complications of Crohn's disease and ulcerative colitis. The incidence of these manifestations varies widely but, at the time of diagnosis, the mean incidence is around 10%. During the course of the disease, a great variety of skin lesions may develop, many of which are secondary to granulomatous cutaneous disease, reactive skin eruptions, nutritional deficiency and other associated conditions. The disorders that are directly related to the inflammatory process of Crohn's disease include perianal and peristomal ulcers and fistulae, metastatic Crohn's disease and oral granulomatous lesions. Histologically, the features are similar to those found in the inflamed bowel. These lesions usually respond to treatment of the underlying intestinal disease. The most common forms of reactive skin eruption are erythema nodosum and pyoderma gangrenosum. Certain subsets of patients are more susceptible to the development of erythema nodosum; in a previous report from our group, erythema nodosum was seen mainly in females, and in patients with colonic involvement and/or arthritis. This manifestation tends to occur during the first 2 years of the clinical course of the disease and may recur in approximately one‐half of cases. Infliximab is highly effective in healing refractory lesions of erythema nodosum and pyoderma gangrenosum. Manifestations that are secondary to nutritional deficiency or associated conditions include acrodermatitis enteropathica, psoriasis and autoimmune disorders. For most of the cutaneous manifestations, the primary therapeutic target remains the bowel. Early aggressive therapy can minimize severe complications and maintenance treatment may prevent some devastating consequences.

Nodular vasculitis – a novel cutaneous manifestation of autoimmune colitis

“…Of the two, cutaneous manifestations of Crohn’s disease are better described and include septal panniculitis (EN), lobular panniculitis (neutrophilic lobular panniculitis with granulomas), sterile neutrophilic folliculitis (pyoderma gangrenosum), granulomatous dermatoses (granuloma annulare, necrobiosis lipoidica‐like lesions, metastatic Crohn’s disease), vasculitis, psoriasis and lichenoid dermatides 5,6,9 . Cutaneous manifestations of UC are not as well characterized and have hitherto been confined to rare case reports of septal panniculitis (EN), lobular panniculitis (Weber‐Christian disease), pyoderma gangrenosum and vasculitis including leukocytoclastic vasculitis and polyarteritis nodosa 7,8,10,18 . We present a case of a 51‐year‐old woman with surgically treated UC who developed multiple painful leg nodules that microscopically showed a mixed (septal and lobular) panniculitis with small vessel vasculitis.…”

“…The latter group includes pyoderma gangrenosum, granuloma annulare, necrobiosis lipoidica‐like lesions, vasculitis, psoriasis, lichenoid dermatides and panniculitis 6,7 . Panniculitides associated with AC may be septal (EN) or lobular (neutrophilic lobular panniculitis with granulomas and Weber‐Christian panniculitis) 8–10 . NV as a cutaneous manifestation of AC has, to the best of our knowledge, not been previously reported in the English literature 11 …”

Leukocytoclastic Vasculitis as an Onset Symptom of Crohn’s Disease

“…An increased variety of skin lesions usually develop during the course of the disease, while approximately 10% of IBD patients show cutaneous manifestations at the time of diagnosis. These are generally secondary to granulomatous cutaneous disease, reactive skin eruptions, nutritional deficiency and other associated conditions [3]. …”

“…Apart from the most common cutaneous manifestations that develop in IBD, such as pyoderma gangrenosum (1-2%) and erythema nodosum (3-8%), leukocytoclastic vasculitis is one of the least reported skin lesions that seem to be linked to IBD [3]. Leukocytoclastic vasculitis is a disorder characterized by neutrophilic infiltration and nuclear debris in postcapillary venules [4] and it is believed that it is an immune complex one [5].…”

MR enterography findings in abdominopelvic extraintestinal complications of Crohn's disease

“…Cutaneous CD can be contiguous with the gastrointestinal tract or distant (metastatic). Classical extraintestinal manifestations, related to systemic disease itself are erythema nodosum, pyoderma gangrenosum, psoriasis, oral aphthous stomatitis, and Sweet syndrome; these manifestations are usually recognized at physical examination (26). Enterocutaneous fistulas and perineal manifestation of CD (including draining fistula tracks, abscess formation, and skin tags) can be routinely demonstrated at MRE.…”