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.

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

Figure 1

Mucocutaneous manifestations associated with inflammatory bowel disease (IBD).

Figure 2

Erythematous plaque on the inner aspect of the right thigh of a patient with cutaneous Crohn’s disease.

Figure 3

Aphthous stomatitis in a patient with Crohn’s disease.

Figure 4

Erythematous nodules on the calves of a patient with ulcerative colitis-related erythema nodosum.

Figure 5

Ulcerative lesion with irregular violaceous, undermined borders on the right thigh of a patient with ulcerative colitis-associated pyoderma gangrenosum.

Figure 6

Erythematous papulonodular lesions involving the face of a patient with Sweet’s syndrome associated with Crohn’s disease.

Figure 7

Vegetating plaques localized on the beard region of a patient with ulcerative colitis-associated pyodermatitis vegetans.

Figure 8

Erythematous-edematous reaction involving the injection site of etanercept in the left thigh.

Figure 9

Psoriasiform eruption involving the abdomen and the pubic area of a patient undergoing adalimumab treatment.

Figure 10

Proposed algorithm for psoriasis management in IBD.