12 Different Skin Conditions Related to Crohn’s Disease

Crohn’s disease is a chronic form of inflammatory bowel disease that causes inflammation in the digestive tract. Crohn’s disease causes abdominal pain and cramping, severe diarrhea, weight loss, malnutrition, anemia, bloody stools, and fatigue. While some people can remain symptom-free for a major portion of their lives, others experience severe symptoms that never really go away. Apart from the digestive tract, Crohn’s disease also affects many other parts of the body, especially the skin. Here are some of the different skin conditions related to Crohn’s disease and what to do about them.

Overview of Crohn’s Disease and Skin Conditions

Crohn’s disease is a type of inflammatory bowel disease that causes inflammation in the gastrointestinal tract.(1,2) This causes various symptoms such as severe diarrhea, bloody stools, abdominal pain and cramping, weight loss and malnutrition, and fatigue.(3) Different people experience Crohn’s in different ways, but Crohn’s disease can affect various other parts of the body apart from the digestive system as well. The most commonly affected part in Crohn’s disease is the skin, and nearly 40% of all people with Crohn’s disease tend to experience Crohn’s symptoms on their skin.(4,5)

Here are the different skin conditions that are related to Crohn’s disease.

Crohn’s Disease and Acne

Acne is typically known to be a problem that plagues teenagers all around the world. However, the same acne breakouts that trouble teenagers can also affect people who have Crohn’s disease. However, acne in Crohn’s is not because of the condition itself, but the breakouts happen because of the steroid medications being used for treating Crohn’s.

Steroids are generally prescribed only for a short time to manage the flare-ups of Crohn’s disease. So, once you stop taking these medications, you will find that the breakouts clear up on their own. These steroid medications help reduce the inflammation and also slows down the immune system response in Crohn’s disease, thus giving relief from the symptoms.(6,7)

Crohn’s Disease and Erythema Nodosum

A skin condition known as erythema nodosum causes red and painful bumps to appear on the skin. These typically erupt on the ankles, shins, and in some cases, on the arms. The appearance of these red bumps is one of the most common skin conditions that affect people with Crohn’s disease. It is expected that nearly 15 percent of people with Crohn’s develop erythema nodosum.(8)

Over a period of time, these red bumps slowly change color to become purple. Some people also develop a fever and joint pain when they experience erythema nodosum. The treatment of Crohn’s disease is usually sufficient to help improve this skin condition.

Crohn’s Disease and Skin Tears

People with Crohn’s disease are prone to developing skin tears in the form of anal fissures. Anal fissures are tiny tears that occur on the skin that lines the anus. This happens because of chronic inflammation present in the intestines and also due to severe diarrhea. Anal fissures can lead to bleeding and pain, especially during bowel movements.

While these fissures tend to heal on their own most of the time, but if they don’t, then there are various treatments such as nitroglycerin cream, Botox injections, and other pain-relieving creams that help heal and ease discomfort during a bowel movement. For anal fissures that do not heal with any treatment, surgical intervention might be required.(9,10)

Crohn’s Disease and Pyoderma Gangrenosum

The skin condition of pyoderma gangrenosum is rare and only affects about five percent of people with ulcerative colitis and Crohn’s disease.(11) Pyoderma gangrenosum is characterized by large open sores on the legs and other areas of the body. The condition typically begins with the appearance of small red bumps on the ankles or shins and are often mistaken as insect bites. The bumps continue to grow bigger and eventually combine to form one big open sore.(12)

Treatment for pyoderma gangrenosum involves medication that has to be either rubbed onto the sore or injected into it. You will also need to keep the wound covered with a clean dressing to prevent infection and promote healing.(13)

Crohn’s Disease and Skin Tags

Skin tags are flesh-colored growths that tend to occur in areas where the skin rubs against skin, such as the groin or armpits. In people with Crohn’s disease, skin tags tend to form around hemorrhoids or anal fissures, where the skin is inflamed.

Even though skin tags are harmless, because of being present in the anal area where feces easily gets stuck in them, they may become infected or cause irritation in the anal region. You can prevent infection and pain by wiping properly after each bowel movement and keeping the anal area clean.

Crohn’s Disease and Canker Sores

Canker sores occur inside the mouth, and they can cause a lot of pain when you talk or eat. Canker sores usually occur due to a deficiency of vitamins and minerals. In people with Crohn’s disease, insufficient vitamin and mineral absorption happens in the gastrointestinal tract due to the disease, and as a result, causes the development of canker sores.

You are most likely to notice canker sores tend to develop the most when you have a flare-up of Crohn’s. By managing Crohn’s flare-ups, you can help alleviate the pain and discomfort from canker sores. An over-the-counter topical application cream, like Orajel, can help relieve the pain until the sores heal.(14)

Crohn’s Disease and Psoriasis

Psoriasis, just like Crohn’s disease, is an autoimmune disease that affects the skin, causing red, flaky patches on the skin. Psoriasis develops when the immune system causes the skin cells to multiply rapidly. These excess cells start building up on the skin, causing red and flaky patches.(15)

While Crohn’s disease does not cause psoriasis, but it increases the risk of developing psoriasis in people who already have Crohn’s. There are two biologic drugs, adalimumab (brand name Humira) and infliximab (brand name Remicade), that help treat both Crohn’s disease and psoriasis.(16)

Crohn’s Disease and Fistula

Nearly 50 percent of people with Crohn’s disease go on to develop a fistula, which can be described as a hollow tunnel or connection between two parts of the body.(17) It has been commonly observed that the fistula may connect the intestine to the skin of the vagina or the buttocks. A fistula may also develop as a complication of surgery.

The fistula typically looks like a boil or bump and is very painful. Fluid or stool may also drain out from the opening.

Antibiotics and other medications are used for treating a fistula. However, if the fistula is severe, then you may need to undergo surgery to close up the tunnel.

Crohn’s Disease and Epidermolysis Bullosa Acquisita

Another skin-related disorder of the immune system is epidermolysis bullosa acquisita, which causes blisters to form on any injured skin. These blisters most commonly occur on the hands, feet, elbows, knees, and ankles, and once the blisters heal, they leave significant scars behind.

Corticosteroids are used for treating this skin condition. Corticosteroid drugs such as dapsone can help decrease inflammation, and immunosuppressant drugs are also prescribed to suppress the immune response. People who develop such types of blisters will need to be careful, especially while playing sports or doing physical activities to avoid the injury. Wearing protected clothing can help.(18,19)

Crohn’s Disease and Leukocytoclastic Vasculitis

Leukocytoclastic vasculitis is another skin condition that affects a small number of people with inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis. Leukocytoclastic vasculitis causes the appearance of little, red, and purple spots on the legs. These spots are caused due to inflammation of the small blood vessels in the legs. The spots can be painful or itchy and tend to heal within a couple of weeks. Doctors prescribe corticosteroids and immunosuppressant drugs for treating this skin condition.(20) In some cases, leukocytoclastic vasculitis can even be an onset symptom of Crohn’s disease itself.(21)

Crohn’s Disease and Skin Rash or Sweet’s Syndrome

People with Crohn’s disease can also be affected by the appearance of small red and painful rash or bumps on the neck, arms, head, or torso. This type of rash is a sign of Sweet’s syndrome. However, though this is a rare skin condition, it can affect people with Crohn’s disease. Doctors will treat such a skin rash with corticosteroid pills.

Crohn’s Disease and Vitiligo

Vitiligo is a skin condition that causes certain patches of skin to start losing their color. The disorder happens when the skin cells that manufacture the pigment melanin stop working or die. Melanin is the natural skin pigment that lends color to hair, skin, and eyes.

Though vitiligo in itself is a rare skin condition, it is more likely to affect people who have Crohn’s disease. Makeup can be used to cover up smaller patches of the affected skin, but for larger areas, medications need to be taken that help even out the skin tone.(22)

Conclusion

Crohn’s disease is a progressive disease that affects many other parts of the body. If you notice any type of new skin symptoms such as sores or painful bumps, or even a suspicious rash, you should report them to your doctor immediately. Your doctor will either treat these issues directly or advise you to consult a dermatologist for further treatment.

References:

  1. Baumgart, D.C. and Sandborn, W.J., 2012. Crohn’s disease. The Lancet, 380(9853), pp.1590-1605.
  2. Shanahan, F., 2002. Crohn’s disease. The Lancet, 359(9300), pp.62-69.
  3. Torres, J., Mehandru, S., Colombel, J.F. and Peyrin-Biroulet, L., 2017. Crohn’s disease. The Lancet, 389(10080), pp.1741-1755.
  4. Gravina, A.G., Federico, A., Ruocco, E., Lo Schiavo, A., Romano, F., Miranda, A., Sgambato, D., Dallio, M., Ruocco, V., Loguercio, C. and Romano, M., 2016. Crohn’s disease and skin. United European Gastroenterology Journal, 4(2), pp.165-171.
  5. Parks, A.G., Morson, B.C. and Pegum, J.S., 1965. Crohn’s disease with cutaneous involvement.
  6. Godfrey, K.M. and James, M.P., 1990. Treatment of severe acne with isotretinoin in patients with inflammatory bowel disease. British journal of dermatology, 123(5), pp.653-655.
  7. Yang, Y.X. and Lichtenstein, G.R., 2002. Corticosteroids in Crohn’s disease. The American journal of gastroenterology, 97(4), pp.803-823.
  8. Faulkes, R.E., 2014. Upper limb erythema nodosum: the first presentation of Crohn’s disease. Clinical case reports, 2(5), p.183.
  9. Wolkomir, A.F. and Luchtefeld, M.A., 1993. Surgery for symptomatic hemorrhoids and anal fissures in Crohn’s disease. Diseases of the colon & rectum, 36(6), pp.545-547.
  10. Fleshner, P.R., Schoetz, D.J., Roberts, P.L., Murray, J.J., Coller, J.A. and Veidenheimer, M.C., 1995. Anal fissure in Crohn’s disease: a plea for aggressive management. Diseases of the colon & rectum, 38(11), pp.1137-1143.
  11. Weizman, A.V., Huang, B., Targan, S., Dubinsky, M., Fleshner, P., Kaur, M., Ippoliti, A., Panikkath, D., Vasiliauskas, E., Shih, D. and McGovern, D.P., 2014. Pyoderma gangrenosum among patients with inflammatory bowel disease: a descriptive cohort study. Journal of cutaneous medicine and surgery, 18(5), p.361.
  12. Levitt, M.D., Ritchie, J.K., Lennard‐Jones, J.E. and Phillips, R.K.S., 1991. Pyoderma gangrenosum in inflammatory bowel disease. British journal of surgery, 78(6), pp.676-678.
  13. Sapienza, M.S., Cohen, S. and Dimarino, A.J., 2004. Treatment of pyoderma gangrenosum with infliximab in Crohn’s disease. Digestive diseases and sciences, 49(9), pp.1454-1457.
  14. Bishop, R.P., Brewster, A.C. and Antonioli, D.A., 1972. Crohn’s disease of the mouth. Gastroenterology, 62(2), pp.302-306.
  15. Lee, F.I., Bellary, S.V. and Francis, C., 1990. Increased occurrence of psoriasis in patients with Crohn’s disease and their relatives. American Journal of Gastroenterology, 85(8).
  16. Najarian, D.J. and Gottlieb, A.B., 2003. Connections between psoriasis and Crohn’s disease. Journal of the American Academy of Dermatology, 48(6), pp.805-824.
  17. Crohn’s & Colitis Foundation. 2020. Fistula Removal. [online] Available at: <https://www.crohnscolitisfoundation.org/what-is-crohns-disease/treatment/surgery/fistula-removal> [Accessed 8 September 2020].
  18. Chen, M., O’Toole, E.A., Sanghavi, J., Woodley, D.T., Mahmud, N., Kelleher, D., Weir, D. and Fairley, J.A., 2002. The epidermolysis bullosa acquisita antigen (type VII collagen) is present in human colon and patients with crohn’s disease have autoantibodies to type VII collagen. Journal of investigative dermatology, 118(6), pp.1059-1064.
  19. Livden, J.K., Nilsen, R., Thunold, S. and Schjønsby, H., 1978. Epidermolysis bullosa acquisita and Crohn’s disease. Acta dermato-venereologica, 58(3), pp.241-244.
  20. Zlatanic, J., Fleisher, M., Sasson, M., Kim, P. and Korelitz, B.I., 1996. Crohn’s disease and acute leukocytoclastic vasculitis of skin. American Journal of Gastroenterology (Springer Nature), 91(11).
  21. Tsiamoulos, Z., Karamanolis, G., Polymeros, D., Triantafyllou, K. and Oikonomopoulos, T., 2008. Leukocytoclastic vasculitis as an onset symptom of Crohn’s disease. Case reports in gastroenterology, 2(3), pp.410-414.
  22. McPoland, P.R. and Moss, R.L., 1988. Cutaneous Crohn’s disease and progressive vitiligo. Journal of the American Academy of Dermatology, 19(2), pp.421-425.

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