COPENHAGEN, Denmark — People with inflammatory bowel disease (IBD) commonly develop skin lesions linked to their condition, but until now few researchers looked at how common they are.
Almost 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, single-center study.
“Skin lesions in IBD patients are much more prevalent than it is generally accepted. The lesions may be related to the pathogenesis of IBD, but it is very important to know that the modern biological therapies may also cause skin lesions,” said senior study author Laimas Jonaitis, MD, PhD, professor in the Department of Gastroenterology at the Lithuanian University of Health Sciences in Kaunas.
“If the gastroenterologist is experienced and has enough competence, he or she may establish the diagnosis, but in all other cases it is wise and advisable to refer the patient to the dermatologist,” Jonaitis said. A referral should include the history and full treatment for IBD.
The results were presented as a poster at the European Crohn’s and Colitis Organisation (ECCO) 2023 Congress in Copenhagen, Denmark, and virtually.
Jonaitis and colleagues conducted a literature analysis to determine the prevalence of extra-abdominal manifestations of IBD. The lack of published data prompted them to survey 152 consecutive patients with IBD receiving outpatient treatment at their institution. The patients completed questionnaires from January to October 2022 about any cutaneous lesions.
The mean age of patients was 42 years, and 58% were men. A majority, 72%, had ulcerative colitis, and 28% had Crohn’s disease.
Prevalence of Skin Lesions
A total 43% of participants reported skin lesions, but only 30% of patients had lesions considered related to IBD or IBD therapy due to their emergence after the patient’s IBD diagnosis.
By IBD diagnosis, 29% of patients with ulcerative colitis and 33% of patients with Crohn’s disease had lesions related to their condition. The difference in skin lesion prevalence between the two groups was not significant (P > .05), the researchers note.
The team further investigated the types of skin lesions deemed to be 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 1 patient each.
Specifically, among patients with ulcerative colitis, skin lesions were reported in 8 of 27 with left-sided colitis, 2 of 15 with ulcerative colitis proctitis, and 22 of 67 patients with pancolitis. The difference between the groups of proctitis and pancolitis was significant (P = .03).
Within the group with Crohn’s disease, skin lesions were reported in 3 of 15 patients with ileitis, 4 of 10 with colitis, and 7 of 17 with ileocolitis. The difference among these groups was not significant (P > .05).
The most common skin lesions observed in Crohn’s disease were erythema nodosum and eczema, and in ulcerative colitis, psoriasis and eczema, the researchers report.
They also note that the cutaneous lesions were significantly more prevalent in extensive ulcerative colitis compared with distal disease.
Skin Lesions Add to Patient Misery
“Skin lesions are considered a burden to patients with IBD and add to their suffering,” said Sara Mesilhy, MBBS, a gastroenterologist with the Royal College of Physicians in the UK, who was not affiliated with the research.
The severity and location of the disease appears to play a role because researchers found extensive ulcerative colitis may carry a higher risk for the development of skin lesions, Mesilhy noted.
The first step when facing skin lesions is to control the disease activity via the best treatment option, Mesilhy suggested.
The study was independently supported. Jonaitis and Mesilhy have disclosed no relevant financial relationships.
European Crohn’s and Colitis Organisation (ECCO) 2023 Congress: Abstract P866. Presented March 3, 2023.
Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology and critical care. Follow Damian on Twitter: @MedReporter. For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.