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Cutaneous Manifestations in Patients With Inflammatory Bowel Diseases: Pathophysiology, Clinical Features, and Therapy

Marzano, Angelo V. MD*; Borghi, Alessandro MD; Stadnicki, Antoni MD‡,§; Crosti, Carlo MD*; Cugno, Massimo MD

doi: 10.1097/01.MIB.0000436959.62286.f9
Clinical Review Articles

Abstract: The skin is one of the most common extraintestinal organ system affected in patients with inflammatory bowel disease (IBD), including both Crohn's disease and ulcerative colitis. The skin manifestations associated with IBD are polymorphic and can be classified into 4 categories according to their pathophysiology: (1) specific, (2) reactive, (3) associated, and (4) induced by IBD treatment. Cutaneous manifestations are regarded as specific if they share with IBD the same granulomatous histopathological pattern: perianal or metastatic Crohn's disease (commonly presenting with abscesses, fistulas or hidradenitis suppurativa-like features) is the prototype of this setting. Reactive cutaneous manifestations are different from IBD in the histopathology but have close physiopathological links: pyoderma gangrenosum, a neutrophil-mediated autoinflammatory skin disease typically manifesting as painful ulcers, is the paradigm of this group. Among the cutaneous diseases associated with IBD, the most commonly seen are erythema nodosum, a form of panniculitis most commonly involving bilateral pretibial areas, and psoriasis, a T helper 1/T helper 17–mediated erythematous squamous inflammatory disease. Finally, the number of cutaneous adverse reactions because of IBD therapies is progressively increasing. The most frequent drug-induced cutaneous manifestations are psoriasis-like, eczema-like, and lichenoid eruptions, as well as cutaneous lupus erythematosus for biologics, and nonmelanoma skin cancer, mainly basal cell and squamous cell carcinomas for thiopurines.

Article first published online 7 October 2013

*Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy;

Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy;

Department of Basic Biomedical Sciences, Medical University of Silesia, Katowice, Poland;

§Section of Gastroenterology, Multidisciplinary Hospital, Jaworzno, Poland; and

Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Medicina Interna, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.

Reprints: Massimo Cugno, MD, Internal Medicine, University of Milan, Via Pace 9, Milano 20122, Italy (e-mail:

The authors have no conflicts of interest to disclose.

Received July 29, 2013

Accepted August 26, 2013

© Crohn's & Colitis Foundation of America, Inc.
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