Occurrence of skin manifestations in patients of the Swiss Inflammatory Bowel Disease Cohort Study.

Nina Roth,Stephan R Vavricka,Michael Scharl,Alexander A Navarini,Luc Biedermann,Gerhard Rogler,Nicolas Fournier,Matthias Butter,Pal Bela Szecsi

doi:10.1371/journal.pone.0210436

Abstract

Background/AimsExtraintestinal cutaneous manifestations of IBD represent a severe disease complication and an early and accurate treatment might positively influence the disease course. Using the patient collective of the Swiss IBD Cohort Study (SIBDCS), we analysed epidemiological as well as clinical factors being associated with the onset of pyoderma gangrenosum, erythema nodosum and aphthous ulcers in IBD patients.MethodsWe included 3266 SIBDCs patients, 1840 with Crohn’s disease (CD) and 1426 with ulcerative colitis (UC) or IBD unclassified (IBDU) and analysed the association of cutaneous manifestations with age, age at diagnosis time, type of disease, gender, family history, HLA-allotype, smoking, intestinal disease activity, therapy and other extraintestinal manifestations (EIM).Results354 CD patients and 136 UC/IBDU patients presented with skin manifestations at any time during their disease course. In both, CD and UC, female gender and younger age at IBD diagnosis were significantly associated with extraintestinal skin manifestations. For CD, we also detected a positive family history as associated factor. As an indicator of more intensive intestinal disease activity, patients with cutaneous manifestations of IBD needed more frequently therapy with antibiotics, steroids, immunomodulators and anti-TNF. Multivariate analysis revealed female gender, younger age at diagnosis and presence of other extraintestinal manifestations as factors being associated with skin EIM in IBD patients and anti-TNF as well as immunomodulatory treatment in CD patients.ConclusionOur results suggest that young females with a positive family history of IBD might be at increased risk for the onset of skin manifestations and require a careful screening for such complications.

Highlights

Inflammatory bowel disease (IBD) patients are commonly affected by extraintestinal manifestations (EIM) affecting the joints, skin, eyes, and biliary ducts, the overall appearance ranges from 6% to 47% [1,2,3,4,5,6,7,8,9] and up to 10% at the time of IBD diagnosis [10]
354 Crohn’s disease (CD) patients and 136 ulcerative colitis (UC)/IBD unclassified (IBDU) patients presented with skin manifestations at any time during their disease course
CD and UC, female gender and younger age at IBD diagnosis were significantly associated with extraintestinal skin manifestations

Summary

Introduction

Inflammatory bowel disease (IBD) patients are commonly affected by extraintestinal manifestations (EIM) affecting the joints, skin, eyes, and biliary ducts, the overall appearance ranges from 6% to 47% [1,2,3,4,5,6,7,8,9] and up to 10% at the time of IBD diagnosis [10]. We have recently shown that in 25.8% of patients of the Swiss IBD Cohort Study (SIBDCS) EIM occur even before IBD is diagnosed [14]. In the SIBDCS this constellation occurred in 15% of Crohn’s disease (CD) and 8% of ulcerative colitis (UC) patients [11]. Most patients with EIM present with a severe colitis and some of them reveal a positive family history for IBD [15, 17]. This allows the assumption, that there is at least some genetic influence

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