Extraintestinal Manifestations of Inflammatory Bowel Disease: Focus on the Musculoskeletal, Dermatologic, and Ocular Manifestations

Paul E. Evans, MD; Darrell S. Pardi, MD


March 19, 2007

Dermatologic Manifestations

Erythema nodosum and pyoderma gangrenosum are the inflammatory cutaneous disorders most commonly associated with IBD. These 2 skin manifestations occur in 3%-12% of patients with IBD.[2,9,25] Erythema nodosum is more common among women with IBD and in patients with Crohn's disease; it typically appears as painful, red, subcutaneous nodules on extensor surfaces and mirrors disease activity (Figure 1).[7] Biopsy shows focal panniculitis. Pyoderma gangrenosum typically presents as ulcerated lesions that appear independent of disease activity, and is more difficult to treat (Figure 2).[26] Results of biopsy reveal a sterile abscess. Pyoderma gangrenosum can be induced or worsened by trauma and may appear around stoma or skin biopsy sites, a process referred to as pathergy.[7]

Figure 1.

Erythema nodosum. (Courtesy of Mayo Clinic Department of Dermatology)

Figure 2.

Pyoderma gangrenosum. (Courtesy of Mayo Clinic Department of Dermatology)

Erythema nodosum responds well to steroids and treatment of the underlying bowel disease.[27] Refractory cases may respond to infliximab.[28] Pyoderma gangrenosum is generally more resistant to treatment, and rapid aggressive therapy is recommended. Options include high-dose oral or intravenous steroids, cyclosporine, oral and topical tacrolimus, and mycophenolate mofetil.[27] Pyoderma gangrenosum also responds well to infliximab, which is a favorable option for patients who do not respond quickly to high-dose corticosteroids or are unable to be weaned off corticosteroids.[29]

Aphthous stomatitis appears as shallow tender ulcers in the oral cavity that can be associated with IBD. These lesions typically respond well to treatment of the underlying condition. Viral lesions such as herpes simplex should also be considered.[30]


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