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Dermatologic manifestations in pediatric patients with inflammatory bowel disease
Mohsen Afarideh1, Katherine Bartoletta2, Megha M Tollefson1,2
1Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Dermatologic conditions are common in children with inflammatory bowel disease (IBD), with infections being most frequent. Crohn's disease (CD) patients show more angular cheilitis and perianal issues, while severe IBD correlates with psoriasis and pyoderma gangrenosum.
Area of Science:
- Pediatric Gastroenterology
- Dermatology
- Inflammatory Bowel Disease Research
Background:
- Limited data exists on the prevalence and severity correlation of skin lesions in pediatric inflammatory bowel disease (IBD).
- Previous studies focused primarily on adult IBD patients, leaving a knowledge gap in understanding pediatric IBD-associated dermatoses.
- This study addresses the need for comprehensive data on skin manifestations in children with IBD.
Purpose of the Study:
- To determine the prevalence of dermatologic manifestations in children with IBD.
- To investigate the correlation between IBD severity and specific skin lesions in pediatric patients.
- To compare the occurrence of skin conditions between Crohn's disease (CD) and ulcerative colitis (UC) in children.
Main Methods:
- Retrospective chart review of 528 pediatric patients (≤18 years) diagnosed with IBD at Mayo Clinic between 1999 and 2017.
- Statistical analysis using Chi-Square/Fischer's exact test (p≤0.05) to compare outcomes between CD and UC cohorts.
- Inclusion criteria required patients to have at least one dermatologic diagnosis recorded.
Main Results:
- Out of 425 IBD patients with dermatologic diagnoses, infections were most common (42.8%).
- Acne (30.8%), eczema (15.8%), and perianal skin tags (14.6%) were prevalent non-infectious conditions.
- Children with CD showed higher rates of angular cheilitis, keratosis pilaris (KP), and perianal complications (p<0.05).
- Fungal skin infections were more common in UC patients (p=0.017).
- Severe IBD correlated with increased prevalence of perianal fistula/abscess, psoriasis, and pyoderma gangrenosum (PG) (p<0.05).
Conclusions:
- Dermatologic conditions, particularly infections, are highly prevalent in pediatric IBD.
- Children with CD are more prone to angular cheilitis, KP, and perianal skin issues compared to UC patients.
- Perianal disease, psoriasis, and PG are significantly associated with more severe pediatric IBD.
Background:
Despite studies of dermatologic manifestations in adults with inflammatory bowel disease (IBD), little is known about the prevalence of IBD-associated skin lesions and their correlation with IBD severity in children. We aimed to address these knowledge gaps in our single-center cohort of children with IBD.
Methods:
Retrospective chart review of 528 children and adolescents (≤18 years old) with IBD and seen at Mayo Clinic (Rochester, MN) between 1999 and 2017 was conducted. The Chi-Square/Fischer's exact test (with p ≤ .05 to signify statistical significance) was applied to compare categorical outcomes between Crohn's disease (CD) and ulcerative colitis (UC) patients.
Results:
In total, 425 IBD patients (64.9% CD, 53% males) and ≥1 dermatologic diagnosis were included. Presence of ≥1 cutaneous infection was recorded in 42.8% of participants. Acne was the most common non-infectious dermatologic condition (30.8%), followed by eczema (15.8%) and perianal skin tags (14.6%). Angular cheilitis (p = .024), keratosis pilaris (KP, p = .003), and perianal skin complications (i.e., skin tags, fistula, and abscesses; all p < .001) were more frequently diagnosed among children with CD, while fungal skin infections (p = .017) were more frequently diagnosed in UC patients. Severity of IBD correlated with higher prevalence of perianal fistula (p = .003), perianal abscess (p = .041), psoriasis (p < .001), and pyoderma gangrenosum (PG, p = .003).
Conclusions:
Both IBD-specific and IBD-nonspecific dermatologic conditions are very prevalent in childhood IBD, the most common being infectious. Children with CD are more likely to experience angular cheilitis, KP, and perianal skin findings than those with UC. Perianal disease, psoriasis, and PG are associated with more severe IBD.
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