Abstract
BackgroundExtraintestinal manifestations of Crohn's disease may involve the skin, the eyes, the genital mucosa, and the joints. Dermatoses associated with Crohn's disease include neutrophilic dermatoses, erythema nodosum, granulomatous dermatitis, blistering dermatoses, and non-specific skin manifestations. Cutaneous Crohn's disease is characterized by skin non-caseating epithelioid granulomatas with giant cells, remote from the gastrointestinal tract. We report herein two new cases.ObservationsOn both patients, differential diagnosis of neutrophilic dermatoses and infectious disease were evoked, and antimicrobial agents were introduced in one of them. Given the atypical presentation, the final diagnosis of cutaneous Crohn's disease could only be made with histological examination. In patient 1, the plaques decreased in size and infiltration by more than 75% after 3 weeks of treatment with bethametasone dipropionate 0.05% cream. In patient 2, the plaques decreased by more than 50% after 6 weeks of treatment with prednisolone (45 mg/day) and azathioprine (100 mg/day).DiscussionCutaneous Crohn's disease may present as dusky, erythematous, infiltrated, and ulcerated plaques and nodules. Female-to-male sex ratio is about 2, and the mean age at onset is 35. Recurrently, the hypothesis of a skin mycobacterial or fungal infection greatly delays proper treatment. Rarity of cutaneous Crohn's disease hampers therapeutic assessment in controlled trials. Thus, available literature is limited to case reports and sparse small series, with contradictory results. These reports are subject to publication bias, and no definite evidence-based recommendations can be made on the most adequate therapeutic strategy.
Highlights
Extraintestinal manifestations of Crohn's disease may involve the skin, the eyes, the genital mucosa, and the joints
The range of skin manifestations associated with Crohn's disease includes neutrophilic dermatoses such as pyoderma gangrenosum and Sweet's syndrome, various panniculitis such as erythema nodosum, granulomatous dermatitis exemplified by palisading granulomatous dermatitis and necrobiosis lipoidica [5], blistering dermatoses such as epidermolysis bullosa acquisita and erythema multiform, and non-specific skin manifestations such as adverse drug reactions and malabsorption-associated dermatologic changes
Cutaneous Crohn's disease, called metastatic Crohn's disease, is a rare manifestation characterized by a prominent non-caseating granulomatous inflammation developing in the skin
Summary
We here report two cases of cutaneous Crohn's disease, where the diagnosis proved difficult due to the lack of specificity of the cutaneous clinical signs In both cases, the definite diagnosis was obtained – after ruling out an infectious disease – by histology, which shows a granulomatous infiltrate. There does not seem to be any correlation between the intestinal and the cutaneous activity of Crohn's disease [6,7] as it was the case for patient 1 These skin lesions are predominantly found in the genital region and on lower extremities but have as well been described on the face, the abdomen, the perineum, the flexural areas (submammary folds, retroauricular region, groin, and abdominal folds) [6,8]. Even when gastrointestinal Crohn's disease has been previously diagnosed, cutaneous Crohn's disease can be clinically confused with various differential diagnoses, such as pyoderma gangrenosum or mycobacterial skin infections, that were both considered in our patients. Corticosteroids administered either topically or systemically were greatly efficient
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