P339 Dermatological evaluation of candidates with IBD for biological therapy - should it become part of the scheme during qualification?

Abstract

Abstract Background Oncological anxiety associated with biological therapy is a common challenge in inflammatory bowel disease (IBD) and it have raised questions about the need for dermatological assessment of the skin before starting a biological therapy to exclude cutaneous malignancies. Methods The aim of the study was to assess the frequency of skin cancers in IBD patients before starting biological therapy. We conducted a retrospective, single-centre evaluation on the frequency of skin cancers. Results A group of patients with IBD who were referred for qualification for biological treatment consisted of n = 805 patients, out of which 348 (43.2%) were female and 457 (56.8%) were male. Average age of patients was 36.84 ± 12.49 years. During qualification for biological treatment dermatological skin assessment was performed and dermal lesions were found in 15.5% (125) patients, of which 9 (1.1%) were cutaneous malignancies. Only steroid dependance and resistance differentiated in a significant way between patients with and without dermal lesions. Dermal lesions group included lower proportion of patients with steroid dependence (84.6% vs 92.9% in group without dermal lesions) and higher proportion of patients with steroid resistance (13.6% vs 7.1% in groups of patients with no dermal lesions) (V = 0.09, CI95 [0.01;0.17], p = 0.022). Surprisingly, there was no effect of thiopurines on development of dermal lesions between group with and without dermal lesions 90.4% vs. 84.6%, MD = 0.06, CI95 [0.01;0.12], p = 0.118. In a multivariate logistic regression model only higher BMI (OR = 1.08, CI95 [1.02;1.14], p = 0.007) was identify as a risk factor for development a dermal lesions. Additionally, as many as 9 patients were diagnosed with cutaneous malignancies, including 4 basal cell carcinomas (BCC), 4 squamous cell carcinomas (SCC) and one MSC. Only 11.4% patients complied with our strict policy of skin surveillance every 6-8 months. Conclusion In this study, we observed dermal lesions in 15.5% of patients, of which 1% were cutaneous malignancies. The only risk factor for dermal lesions was higher BMI. The lack of effect of thiopurines on oncological risk may indicate the need to monitor the skin condition in every patient with IBD. It is also crucial to disseminate knowledge about the need for regular skin assessments among IBD patients.