People with While inflammatory bowel disease (IBD) often has skin symptoms related to their intestinal disease, few scientists have studied how common they are. Nearly one-third of patients with ulcerative colitis or Crohn’s disease develop skin lesions — such as psoriasis, eczema and erythema nodosum — related to their condition, according to the prospective, monocentric study.
«Skin lesions in IBD patients are much more common than is generally believed.The lesions may be related to the pathogenesis of IBD, but it is very important to know that even the modern biological therapies can cause skin lesions,» said the lead author of the study, Dr. Laimas Jonaitis, a professor in the Department of Gastroenterology at the Lithuanian University of Health Sciences in Kaunas. «If the gastroenterologists have sufficient experience and competence, they can make the diagnosis, but in all other cases it is wise and advisable to refer patients to dermatology,» says Jonaitis. A referral should include the medical history and complete information about treatment for IBD. The results were presented virtually and in the form of a poster at the 2023 Congress of the European Crohn’s and Colitis Organisation (ECCO) in Copenhagen.
Jonaitis and colleagues conducted a literature review to determine the prevalence of extra-abdominal manifestations of IBD. The lack of published data led them to interview 152 consecutive patients with IBD who were treated on an outpatient basis at their facility.Patients completed questionnaires about any skin changes from January to October 2022. The average age of patients was 42 years and 58% were men. The majority, 72%, suffered from ulcerative colitis, and 28% had Crohn’s disease.
Prevalence of skin lesions
A total of 43% of participants reported skin lesions, but only 30% of patients had lesions considered associated with IBD or IBD therapy as they occurred after the patient’s IBD diagnosis. After IBD diagnosis, 29% of patients with ulcerative colitis and 33% of patients with Crohn’s disease had lesions associated with their disease. The difference in the prevalence of skin lesions between the two groups was not significant (P> 0.05), the scientists said. The team also looked at the types of skin lesions associated with IBD or IBD therapy.
Overall, they found psoriasis in 9 patients, eczema in 9, erythema nodosum in 6, pyoderma gangrenosum in 5, allergic rash in 4, and vitiligo in 2.They found acne, epidermolysis bullosa acquisita and hemorrhagic vasculitis in one patient each. Among patients with ulcerative colitis, skin changes were found in 8 out of 27 patients with left-sided colitis, in 2 out of 15 patients with ulcerative colitis proctitis, and in 22 out of 67 patients with pancolitis. The difference between the groups with proctitis and pancolitis was significant (P = 0.03). Within the Crohn’s disease group, skin lesions were found in 3 out of 15 patients with ileitis, 4 out of 10 with colitis, and 7 out of 17 with ileocolitis. The difference between these groups was not significant (P> 0.05).
The most common skin lesions observed in Crohn’s disease were erythema nodosum and eczema, while psoriasis and eczema were observed in ulcerative colitis, the scientists report. In addition, they found that the skin lesions occurred significantly more frequently in extensive ulcerative colitis than in distal disease.
Skin lesions burden patients
«Skin lesions are perceived as a burden by patients with IBD and contribute to their suffering,» said Sara Mesilhy, MBBS, a gastroenterologist at the Royal College of Physicians in the UK, who was not involved in the study.The severity and localization of the disease appear to play a role, because the scientists found that extensive ulcerative colitis carries a higher risk of developing skin lesions, Mesilhy said. The first step in skin lesions is to control disease activity through the best treatment option, Mesilhy suggested.
This article was originally published on Medscape.com. It has been translated by Dr. Petra Kittner.
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