Management of cutaneous disorders related to inflammatory bowel disease

Abstract

Almost one-third of patients with inflammatory bowel disease (IBD) develop skin lesions. Cutaneous disorders associated with IBD may be divided into 5 groups based on the nature of the association: specific manifestations (orofacial and metastatic IBD), reactive disorders (erythema nodosum, pyoderma gangrenosum, pyodermatitis-pyostomatitis vegetans, Sweet's syndrome and cutaneous polyarteritis nodosa), miscellaneous (epidermolysis bullosa acquisita, bullous pemphigoid, linear IgA bullous disease, squamous cell carcinoma-Bowen's disease, hidradenitis suppurativa, secondary amyloidosis and psoriasis), manifestations secondary to malnutrition and malabsorption (zinc, vitamins and iron deficiency), and manifestations secondary to drug therapy (salicylates, immunosupressors, biological agents, antibiotics and steroids). Treatment should be individualized and directed to treating the underlying IBD as well as the specific dermatologic condition. The aim of this review includes the description of clinical manifestations, course, work-up and, most importantly, management of these disorders, providing an assessment of the literature on the topic.

Keywords: Inflammatory bowel disease; skin disorders; treatment.

Figure 1

Metastatic Crohn’s disease. Ulcerative and crusting lesion

Figure 2

Erythema nodosum. Multiple red, warm, and tender nodules, classically located on pretibial surface of lower extremity

Figure 3

Pyoderma gangrenosum. Painful and irregularly shaped ulcers with violaceous edges

Figure 4

Sweet’s syndrome. Painful, red, tender edematous papules with pseudovesiculation

Figure 5

Hidradenitis suppurativa. Subcutaneous nodules, sinus tracts, fistulae formation and dermal scarring