Crohn’s Disease and Skin Conditions
Patients with Crohn’s disease (CD) may know that one of the more common comorbidities (conditions that occur at the same time as a primary condition or disease) that can occur is rashes and other skin conditions. While these rashes can be harmless, many of them can be unsightly, painful, and some of them can even lead to dangerous infections.
While these skin disorders can be both related to CD or directly caused by CD, they can also be found in other inflammatory bowel diseases such as ulcerative colitis. Some may also be more common in women or men, and most of them require some kind of treatment intervention to relieve symptoms.
Erythema nodosum is a common skin disorder in Crohn's
Erythema nodosum (EN) is one of the most common skin disorders in patients with CD.1 EN may look like bruises, but they will feel like large raised bumps under the skin.2
They are usually warm to the touch, and very tender or even painful. EN is most commonly found on the legs, but it may occur in other places. Women tend to be more affected by EN than men, but there have been studies that show it happens equally in men and women.1 The treatment for EN is rest, oral corticosteroids, and in severe cases, immunosuppressive agents.3
Psoriasis and Crohn's disease
Psoriasis and CD both appear to be linked in how they affect the immune system, which seems to explain why they are linked.2 Psoriasis causes red, itchy, scaly patches on the skin, which are known as plaques.3
These patches are common on the joints (knees and elbows), the scalp and the chest and stomach area, but can occur anywhere on the body. Psoriasis may also cause changes in nail growth. The most common treatments for psoriasis include topical corticosteroids, topical salicylic acid, systemic immunosuppressive agents, and injectable biological therapies.3
Pyoderma gangrenosum (PG) is one of the more common skin disorders in CD patients.1 PG is often the immune system’s overreaction to minor trauma such as a needle stick or a surgical wound.2
It usually starts as a small bump or nodule under the skin which eventually becomes a deep, painful ulcer or crater-like hole in the skin. These ulcers are usually found at surgical sites but are also often found on the legs and feet.3
This condition is also supposed to be more common in women than men, but again, other studies have found that this can happen equally among both.12
What are other skin conditions linked to Crohn's?
While these are the most common skin conditions associated with CD, there are some other, less common skin conditions that may occur.
- Continuous/Contiguous CD; Metastatic CD – Patients with continuous CD often experience rashes and inflammation around the anal region. These rashes can become ulcers (open wounds), or abscesses (pus-filled pockets), and can range from painless to very painful.2 Patients may also have CD in their mouth, such as sores on the insides of the cheeks and lips. Very rarely, patients may experience symptoms of CD in other areas of the body, such as the armpits, legs, groin, and face.3 These metastatic lesions are treated with oral corticosteroids, immunosuppressive agents and biological therapies.3
- Skin conditions related to nutritional deficiencies – CD and some treatments of CD can cause the body to absorb the nutrients that it needs from food.2 The most common of these are zinc, iron, and fatty acid deficiencies, which can cause, raised red patches, dry skin and eczema, nail changes, and inflammation of the mouth and lips.2 These conditions are usually treated by taking an oral supplement of the missing nutrient.
There are many other skin diseases associated with CD; these are just some of the more commonly seen disorders. Patients make experience symptoms related to other autoimmune symptoms such as vitiligo, or loss of pigment in the skin.2
Patients may also experience rashes associated with inflammation of the blood vessels, called vasculitis.3 Other less common disorders in CD include Sweet’s syndrome and bowel-associated dermatosis-arthritis syndrome (BADAS).
Both of these diseases present as fevers and rashes, but BADAS occurs in patients who have undergone bowel bypass surgery and is also accompanied by arthritis.3 While these diseases are less common, they can occur in CD patients.
If you notice any changes in your skin, contact your health care team or see your physician as soon as possible. Many of these skin changes can be painful, and some can lead to infections. Early intervention can help you experience less pain and help prevent infection.
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