Skin manifestations of inflammatory bowel disease

Abstract

Inflammatory bowel disease (IBD) is a disease that affects the intestinal tract via an inflammatory process. Patients who suffer from IBD often have diseases that affect multiple other organ systems as well. These are called extraintestinal manifestations and can be just as, if not more debilitating than the intestinal inflammation itself. The skin is one of the most commonly affected organ systems in patients who suffer from IBD. The scientific literature suggests that a disturbance of the equilibrium between host defense and tolerance, and the subsequent over-activity of certain immune pathways are responsible for the cutaneous disorders seen so frequently in IBD patients. The purpose of this review article is to give an overview of the types of skin diseases that are typically seen with IBD and their respective pathogenesis, proposed mechanisms, and treatments. These cutaneous disorders can manifest as metastatic lesions, reactive processes to the intestinal inflammation, complications of IBD itself, or side effects from IBD treatments; these can be associated with IBD via genetic linkage, common autoimmune processes, or other mechanisms that will be discussed in this article. Ultimately, it is important for healthcare providers to understand that skin manifestations should always be checked and evaluated for in patients with IBD. Furthermore, skin disorders can predate gastrointestinal symptoms and thus may serve as important clinical indicators leading physicians to earlier diagnosis of IBD.

Keywords: Crohn’s disease; inflammatory bowel disease; skin disorders; ulcerative colitis.

Figure 1

Perianal fissure in a patient with IBD. Note the longitudinal tear pattern in the anoderm.

Figure 2

Aphthous stomatitis of the oral mucosa. Note the erythematous ring around the yellow to gray colored ulceration in this minor aphthous stomatitis.

Figure 3

Erythema nodosum manifested as erythematous nodules of the skin. These lesions are often painful and assume a bruise-like appearance.

Figure 4

Pyoderma gangrenosum can start as small pustules that as they progress form larger and deeper ulcers. Classically, the borders of the lesions are mucopurulent and purple. Example of pyoderma gangrenosum lesion involving the leg (A) and parastoma (B).