Review article: skin complications associated with inflammatory bowel disease

Area of Science:

• Gastroenterology
• Dermatology
• Internal Medicine

Background:

• Cutaneous manifestations are frequent complications of inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC).
• Approximately 10% of patients exhibit skin issues at the time of IBD diagnosis, with varied incidence throughout the disease course.
• These manifestations stem from granulomatous disease, reactive eruptions, nutritional deficiencies, and associated conditions.

Purpose of the Study:

• To review the spectrum of cutaneous manifestations associated with Crohn's disease and ulcerative colitis.
• To discuss the direct and indirect relationships between intestinal inflammation and skin lesions.
• To highlight therapeutic strategies targeting both intestinal and dermatological aspects.

Main Methods:

• Literature review of studies on IBD-associated skin conditions.
• Analysis of the pathophysiology linking bowel inflammation to dermatological changes.
• Evaluation of treatment outcomes for various cutaneous manifestations.

Main Results:

• Directly related disorders include perianal/peristomal ulcers/fistulae, metastatic CD, and oral granulomas, often responding to bowel treatment.
• Common reactive eruptions like erythema nodosum and pyoderma gangrenosum may be linked to specific patient subsets (e.g., females, colonic involvement, arthritis).
• Infliximab shows high efficacy for refractory erythema nodosum and pyoderma gangrenosum; secondary conditions include acrodermatitis enteropathica, psoriasis, and autoimmune disorders.

Conclusions:

• Management of IBD-related skin conditions primarily focuses on treating the underlying intestinal disease.
• Early and aggressive therapeutic interventions can mitigate severe complications.
• Maintenance therapy is crucial for preventing long-term, devastating consequences of these manifestations.