Dermatological Manifestations in Inflammatory Bowel Diseases

Inflammatory bowel diseases (IBDs) may be associated with extra-intestinal manifestations. Among these, mucocutaneous manifestations are relatively frequent, often difficult to diagnose and treat, and may complicate the course of the underlying disease. In the present review, a summary of the most relevant literature on the dermatologic manifestations occurring in patients with inflammatory bowel diseases has been reviewed. The following dermatological manifestations associated with IBDs have been identified: (i) specific manifestations with the same histological features of the underlying IBD (occurring only in Crohn’s disease); (ii) cutaneous disorders associated with IBDs (such as aphthous stomatitis, erythema nodosum, psoriasis, epidermolysis bullosa acquisita); (iii) reactive mucocutaneous manifestations of IBDs (such as pyoderma gangrenosum, Sweet’s syndrome, bowel-associated dermatosis-arthritis syndrome, aseptic abscess ulcers, pyodermatitis–pyostomatitis vegetans, etc.); (iv) mucocutaneous conditions secondary to treatment (including injection site reactions, infusion reactions, paradoxical reactions, eczematous and psoriasis-like reactions, cutaneous infections, and cutaneous malignancies); (v) manifestations due to nutritional malabsorption (such as stomatitis, glossitis, angular cheilitis, pellagra, scurvy, purpura, acrodermatitis enteropathica, phrynoderma, seborrheic-type dermatitis, hair and nail abnormalities). An accurate dermatological examination is essential in all IBD patients, especially in candidates to biologic therapies, in whom drug-induced cutaneous reactions may assume marked clinical relevance.

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Liver Function Test Abnormalities in Patients with Inflammatory Bowel Diseases: A Hospital-based Survey

Clinical Medicine Insights Gastroenterology ◽

10.4137/cgast.s13125 ◽

2014 ◽

Vol 7 ◽

pp. CGast.S13125 ◽

Cited By ~ 11

Author(s):

Maria Cappello ◽

Claudia Randazzo ◽

Ivana Bravatà ◽

Anna Licata ◽

Sergio Peralta ◽

...

Keyword(s):

Liver Function ◽

Fatty Liver ◽

Inflammatory Bowel Diseases ◽

Normal Values ◽

Liver Function Tests ◽

Gamma Glutamyl Transpeptidase ◽

Drug Induced ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Altered Liver

Background and Aims Inflammatory bowel diseases (IBD) are frequently associated with altered liver function tests (LFTs). The causal relationship between abnormal LFTs and IBD is unclear. The aim of our study was to evaluate the prevalence and etiology of LFTs abnormalities and their association with clinical variables in a cohort of IBD patients followed up in a single center. Materials and Methods A retrospective review was undertaken of all consecutive IBD in- and outpatients routinely followed up at a single referral center. Clinical and demographic parameters were recorded. Subjects were excluded if they had a previous diagnosis of chronic liver disease. LFT abnormality was defined as an increase in aspartate aminotransferase, (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), or total bilirubin. Results A cohort of 335 patients (179 males, mean age 46.0 ± 15.6 years) was analyzed. Abnormal LFTs were detected in 70 patients (20.9%). In most cases, the alterations were mild and spontaneously returned to normal values in about 60% of patients. Patients with abnormal LFTs were less frequently on treatment with aminosalicylates (22.8 vs. 36.6%, P = 0.04). The most frequent cause for transient abnormal LFTs was drug-induced cholestasis (34.1%), whereas fatty liver was the most frequent cause of persistent liver damage (65.4%). A cholestatic pattern was found in 60.0% of patients and was mainly related to older age, longer duration of disease, and hypertension. Conclusions The prevalence of LFT abnormalities is relatively high in IBD patients, but the development of severe liver injury is exceptional. Moreover, most alterations of LFTs are mild and spontaneously return to normal values. Drug-induced hepatotoxicity and fatty liver are the most relevant causes of abnormal LFTs in patients with IBD.

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Ustekinumab Successfully Treats and Maintains Remission of Pyostomatitis Vegetans Associated with Crohn’s Disease

Crohn's & Colitis 360 ◽

10.1093/crocol/otaa014 ◽

2020 ◽

Vol 2 (1) ◽

Author(s):

Sarah Abi Doumeth ◽

Ossama Abbas ◽

Jana G Hashash

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Pyoderma Gangrenosum ◽

Inflammatory Bowel Diseases ◽

Pyostomatitis Vegetans ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Biochemical Remission

Abstract Pyostomatitis vegetans (PV) is a rare inflammatory stomatitis often associated with inflammatory bowel diseases (IBD). Treatment of PV depends on the presence of coexisting IBD. To date, there have been no reports on the use of ustekinumab for PV. There have been recent cases on the use of ustekinumab for treatment of pyoderma gangrenosum and uveitis. We report the case of a 26-year-old female with moderately severe Crohn’s disease (CD) and PV who was successfully treated with ustekinumab monotherapy. Since initiation of ustekinumab, she has been in clinical and biochemical remission from a CD and PV standpoint for the last 12 months.

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Neurological presentations of inflammatory bowel diseases

Medical alphabet ◽

10.33667/2078-5631-2021-3-34-42 ◽

2021 ◽

pp. 34-42

Author(s):

Yu. O. Shulpekova ◽

V. U. Ablaev ◽

I. V. Damulin

Keyword(s):

Inflammatory Bowel Diseases ◽

Neurological Disorders ◽

Intestinal Inflammation ◽

Cranial Nerves ◽

Cranial Neuropathy ◽

Drug Induced ◽

Axonal Polyneuropathy ◽

Increased Risk ◽

Bowel Diseases ◽

Inflammatory Bowel

The aim. To characterize the main types of neurological manifestations in inflammatory bowel diseases – Crohn’s disease and ulcerative colitis.Main concepts. Neurological disorders represent an important aspect of extraintestinal inflammatory bowel diseases (IBD) manifestations. According to publications, the incidence of psycho-neurological syndromes varies from 0.25% to 47.50% that apparently depends on the patient’s selection in studies. Neurological signs are not always associated with IBD activity and may precede the manifestation of intestinal inflammation. The most typical include cerebral thromboembolism, peripheral and cranial neuropathies, demyelinating disorders, and cerebral vasculitis. The incidence of ischemic stroke in IBD can reach 6.4%, with approx. 20% of affected persons under 17 y.o. Hemiparesis is the predominant consequence. The risk of intracranial venous thrombosis is increased depending on the activity of intestinal inflammation; this complication can precede manifestation of IBD. Fifty per cent increased risk of multiple sclerosis in IBD patients was shown. The types of peripheral nerves involvement include mononeuropathy, plexopathy, multiple mononeuropathy, compression neuropathy, polyneuropathy and cranial neuropathy. Peripheral neuropathy may be found in 32–37% of IBD patients with a special examination. Demyelinating type, sensory axonal polyneuropathy with thin and thick fibers damage, and motor axonal polyneuropathy with thick fibers damage are observed approximately in equal proportions. It is important to differentiate ‘primary’ neuropathy with vitamin B12 and folic acid deficient, alcoholic, diabetic and drug-induced neuropathy. Clinical improvement is usually seen in the course of immunosuppressive therapy. Cranial neuropathy (mostly of II, VI, VII, VIII of cranial nerves) is described in IBD. Neurological disorders associated with administration of metronidazole, sulfasalazine, cyclosporin A, antibodies to TNF-α and integrins α4 and α4ß7 continue to be highly actual.Conclusion. There is a variety of neurologic syndromes in IBD which represents an important part of extraintestinal manifestations. Mild psychoneurological disorders may be not recognized in time. The majority of symptoms and signs may regress in the course of treatment of IBD and nutrients deficiency correction. The special attention should be paid to neurological status control while the biologic and immunosuppressor agents and metronidazole are administered.

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Case for diagnosis

Anais Brasileiros de Dermatologia ◽

10.1590/s0365-05962012000600022 ◽

2012 ◽

Vol 87 (6) ◽

pp. 929-931 ◽

Cited By ~ 2

Author(s):

Kleyton de Carvalho Mesquita ◽

Izelda Maria Carvalho Costa

Keyword(s):

Ulcerative Colitis ◽

Clinical Improvement ◽

Pediatric Patient ◽

Oral Mucosa ◽

Inflammatory Bowel Diseases ◽

Specific Marker ◽

Pyostomatitis Vegetans ◽

Bowel Diseases ◽

Oral Corticosteroids ◽

Inflammatory Bowel

Pyodermatitis-pyostomatitis vegetans is a rare mucocutaneous dermatosis characterized by pustular and vegetating lesions of the skin and oral mucosa. It is considered a highly specific marker for inflammatory bowel diseases. The authors describe a case of pyodermatitis-pyostomatitis vegetans in a pediatric patient who presented marked clinical improvement after beginning treatment with oral corticosteroids, azathioprine, and dapsone. Bowel surveillance is mandatory, since the dermatosis is associated with inflammatory bowel diseases in more than 70% of patients, especially ulcerative colitis.

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