Dermatological Manifestations in Pediatric Inflammatory Bowel Disease.

Silvia Strat,Ileana Ioniuc,Gabriela Stefanescu,Gheorghe G. Balan,Carmen Anton,Smaranda Diaconescu,Ana Maria Alexandra Stanescu

doi:10.3390/medicina56090425

Abstract

Background and Objectives: Over the last years, inflammatory bowel disease (IBD) has been reported on a high incidence in pediatric populations and has been associated with numerous extraintestinal manifestations, making its management a real challenge for the pediatric gastroenterologist. Dermatological manifestations in IBD are either specific, related to the disease activity or treatment-associated, or non-specific. This literature review aims to identify and report the dermatological manifestations of IBD in children, the correlation between their appearance and the demographical characteristics, the relationship between these lesions and disease activity, and to highlight the impact of dermatological manifestations on an IBD treatment regime. Materials and Methods: A systemic literature review was performed, investigating articles and case reports on dermatological manifestations in children with IBD starting from 2005. A total of 159 potentially suitable articles were identified and after the exclusion process, 75 articles were selected. Results: The most common dermatological manifestations reported in pediatric IBD are erythema nodosum and pyoderma gangrenosum. More rare cases of metastatic Crohn’s disease, epidermolysis bullosa acquisita, small-vessel vasculitis, necrotizing vasculitis, leukocytoclastic vasculitis, cutaneous polyarteritis nodosa, and Sweet’s syndrome have been reported. Oral manifestations of IBD are divided into specific (tag-like lesions, mucogingivitis, lip swelling with vertical fissures, aphthous stomatitis, and pyostomatitis vegetans) and non-specific. IBD treatment may present with side effects involving the skin and mucosa. Anti-tumor necrosis factor agents have been linked to opportunistic skin infections, psoriasiform lesions, and a potentially increased risk for skin cancer. Cutaneous manifestations such as acrodermatitis enteropathica, purpuric lesions, and angular cheilitis may appear secondary to malnutrition and/or malabsorption. Conclusions: The correct diagnosis of dermatological manifestations in pediatric IBD is of paramount importance because of their impact on disease activity, treatment options, and a patient’s psychological status.

Highlights

It is estimated that 6–23% of children with inflammatory bowel disease (IBD) develop extraintestinal manifestations, either related to the disease itself or related to the medication [2,3].In general, extraintestinal manifestations of IBD can be divided into two groups, depending on ulcerative colitis (UC), and IBD-unclassified
Dermatological manifestations are seen in children with both CD and UC, their incidence varying from 10–15% [4]
They are either specific or reactivation lesions or may be related to malabsorption or drugs used in the treatment of IBD; a small group of lesions have been described in the literature concomitant to IBD but are considered miscellaneous lesions (Table 1) [3]

Summary

Introduction

It is estimated that 6–23% of children with IBD develop extraintestinal manifestations (with a higher frequency in those older than six), either related to the disease itself or related to the medication [2,3].In general, extraintestinal manifestations of IBD can be divided into two groups, depending on ulcerative colitis (UC), and IBD-unclassified Mechanism (affecting the joints—peripheral and axial arthropathies; involving the skin—erythema nodosum, Cutaneous manifestations in patients with IBD are usually either specific lesions, reactivation pyoderma gangrenosum, Sweet’s syndrome, aphthous stomatitis; the eye- episcleritis or uveitis) [4,5]. There are independent autoimmune diseases that are highly associated with miscellaneous lesions [4,5] Their diagnosis is based on the clinical characteristic features and on the exclusion of other dermatological disorders. This literature review aims to identify and report the dermatological manifestations of IBD in children, the correlation between their appearance and the demographical characteristics, the relationship between these lesions and disease activity, and to highlight the impact of dermatological manifestations on an IBD treatment regime.

Methods

Results

Conclusion