Abstract
Inflammatory bowel disease (IBD) is a chronic and incurable disease, of unknown etiology, associated with an unregulated immune response to environmental triggers in a genetically predisposed host. IBD affects mainly the gastrointestinal (GI) tract and includes Crohn's disease (CD) and ulcerative colitis (UC). However, a large percentage of patients may present with extraintestinal manifestations, including mucocutaneous ones (which are the most common) and dermatologic findings, such as erythema nodosum, pyoderma gangrenosum, and aphthous stomatitis (which are the most frequently occurring). According to pathophysiologic mechanisms, mucocutaneous manifestations of IBD are classified into five categories, namely, specific manifestations, associated manifestations, reactive manifestations, adverse effects of IBD therapy, and malabsorption manifestations. Recognizing such manifestations should not be performed only by a dermatologist but also other specialties such as internal medicine, gastroenterology, among others. This is because these manifestations can present before the IBD diagnosis, even in the absence of GI symptoms. Therefore, these skin lesions could be a fundamental tool for the earlier diagnosis of IBD. This review provides a comprehensive overview of the most common cutaneous manifestations of IBD with a focus on their epidemiology, diagnostic criteria, clinical presentation, and available medical treatment.
Highlights
BackgroundInflammatory bowel disease (IBD) is a chronic and incurable disease, of unknown etiology, believed to be associated with an unregulated immune response to environmental triggers in a genetically predisposed host [1]
This review provides a comprehensive overview of the most common cutaneous manifestations of IBD with a focus on their epidemiology, diagnostic criteria, clinical presentation, and available medical treatment
IBD affects mainly the gastrointestinal (GI) tract, up to 40% of patients may present with extraintestinal manifestations, which are more common in Crohn's disease (CD) [4], and up to 36.6% have more than one extraintestinal manifestation [5]
Summary
Inflammatory bowel disease (IBD) is a chronic and incurable disease, of unknown etiology, believed to be associated with an unregulated immune response to environmental triggers in a genetically predisposed host [1]. Skin lesions are associated with systemic symptoms, such as fever, arthralgias, myalgias, headache, conjunctivitis, and oral ulcers [8] It is characterized by a diffuse infiltrate with mature neutrophil predominance, typically located in the superior dermis, which rapidly improves after treatment starts [14], or it could spontaneously remit in weeks-months with no scarring [8]. Cutaneous lesions present as papules, pustules, vesicles, and crusts, which coalesce onto vegetant plaques with raised borders, which mainly affect the face, scalp, axillae, groin, and, less frequently, the abdomen, thorax, and distal zone of limbs [4,19] It presents as pseudoepitheliomatous hyperplasia, dermic and epidermic neutrophils, with multiple eosinophilic microabscesses, usually without granulomas [20].
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