Ulcerative Colitis and Skin Conditions

Patients with ulcerative colitis (UC) 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 UC or directly caused by UC, they can also be found in other inflammatory bowel diseases such as Crohn’s disease. Some may also be more common in women or men, and most of them require some kind of treatment intervention to relieve symptoms.

What are the most common skin issues with UC?

Pyoderma gangrenosum (PG) is one of the most common skin disorders in UC 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.1 PG is treated with oral and topical corticosteroids, immunosuppressive agents and injectable biological therapies as a last line of therapy.2

Psoriasis in patients with UC

Approximately 5% of UC patients experience psoriasis.3 Some studies have shown that symptoms of psoriasis can occur up to 15 years prior to the symptoms of UC or other inflammatory bowel diseases.1 Psoriasis and UC 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

What are other common skin conditions linked to UC?

Erythema nodosum (EN) is another common skin disorders in patients with inflammatory bowel diseases.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

Less common skin conditions linked to ulcerative colitis

While these are the most common skin conditions associated with UC, there are some other, less common skin conditions that may occur.

  • Vitiligo- While this disease is rare in patients with inflammatory bowel diseases; it is more common in UC patients than patients with Crohn’s disease.2 Patients with vitiligo have white patches on their skin where the pigment is missing. These patches may occur on the face, hands, feet or joint areas. Vitiligo is an autoimmune disease, and like psoriasis, it appears to be linked to UC because it works on the same immune pathways in the body.
  • Sweet’s syndrome- While rare, Sweet’s Syndrome (SS) is more likely to happen in patients with UC than Crohn’s disease.2,3 Patients with SS experience raised, tender, red or purple patches on their skin, and usually, experience a sudden fever.3 They may also have a headache, and may feel tired, or just generally not well, or not themselves.2 SS is usually treated with oral corticosteroids or immunosuppressive agents.
  • Bowel-associated dermatosis-arthritis syndrome (BADAS)- BADAS occurs in patients who have undergone bowel bypass surgery. Patients usually have a fever and experience flu-like symptoms, followed by aches and pains in the smaller joints of the hands and feet, which may become arthritic.3 They may experience eruptions on the skin that start as flat, reddish spots; these spots may become raised bumps and may fill with fliud.2 Treatment for BADAS is usually systemic corticosteroids (either oral or injection) and antibiotics.2,3

There are many other skin diseases associated with UC, these are just some of the more commonly seen disorders. Patients make experience symptoms related to poor absorption of vitamins and minerals in their food, such as iron, zinc and fatty acid deficiencies.2 Patients may also experience disorders of the mucosal linings of the mouth and anus, as well as rashes associated with inflammation of the blood vessels, called vasculitis.3 While these diseases are less common, they can occur.

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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