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home - IBD - Extra Intestinal Manifestations - Cutaneous Written by Dr Sebastian Zeki

Cutaneous

Cutaneous manifestations Necrotizing cutaneous vasculitisThis is rarely associated with IBD.It is a serious complication which can progress to peripheral gangrene.Aggressive management with high-dose steroids and possible colectomy is indicated. Epidermolysis bullosa acquisitaThis is rarely assoc. with Crohn's disease.Characterised by ulcerating nodules that show noncaseating granulomas on biopsy.It usually occurson the anterior abdominal wall in the submammary area, and on the arms and legs.They respond well to systemic steroids. PsoriasisThis is more common in Crohn’s and relatives of Crohn’s patients.Psoriasis with microscopic psoriasis often have micro-scopic bowel inflammation. Sweet's syndromeThis is characterised by tender, red inflamm-tory nodules or papules, usually affecting the upper limbs, face or neck.It is a neutrophilic dermatosis as is PG.Risk factors include females/ colonic disease/ other EIMs.It can precede, be during active disease or be after proctocolectomy. Pyoderma gangrenosum (PG) Occurs in 5% UC and 2% Crohn’s.Parallels IBD activity in 50%.Patients get pathergy.It is commonly found on the shins and adjacent to stomas.Multiple erythematous papules or pustules, and deep excavating ulcerations can occur.Treatment includes topical and systemic steroids.Ciclosporin or tacrolimus is useful for refractory cases.Infliximab is very effective.Lesions can persist after procto-colectomy. Erythema nodosumOccurs in 15% of IBD.It is characterised by tender, red or violet subcutaneous nodules of 1-5 cm in diameter.It occurs on the extensor surfaces of the extremities esp anterior tibial area.It occurs at times of activity of the colitis. Focal panniculitisTreatment includes treat underlying colitis- takes 1 week to respond.Can use oral potassium iodide if it is refractory. Written by Dr Sebastian Zeki

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