CROHN'S DISEASE

By Gary M. White, MD

Crohn's Disease of the Skin Metastatic Crohn's Disease


There are three skin manifestations of Crohn's disease (CD):

Clinical

Patients with metastatic Crohn's disease may have urticarial, edematous plaques (fixed in location) at times with a peau d'orange appearance. They may also develop inflammatory nodules that may ulcerate. Most of the time, the intestinal Crohn's is known, but rarely, cutaneous MCD may predate the intestinal manifestations.

10-20% of patients with CD have oral manifestations. These include indolent swelling of one or both lips, hyperplastic folds, ulceration, fissuring, polypoid lesions, cobblestone appearance of the buccal mucosa and angular cheilitis.

Perianal Crohn's appears as tags, deep fissuring, and purulent drainage. Cutaneous extension of Crohn's in the perianal or periostomy area may create large abscess-like cavities.

Diagnosis

A biopsy is usually needed for diagnosis. Histologic examination shows granulomas. Of note, Crohn's disease may precipitate Sweet's syndrome which can look similar. See image below.

Treatment

The gastroenterologist should be involved in controlling the Crohn's disease. Human anti-TNFα monoclonal antibodies, e.g., adalimumab and infliximab, have demonstrated great efficacy in inducing and maintaining remission in patients with MCD [JEADV 2016;30;e72].

Topical and systemic steroids (e.g., prednisone 30 mg/day) have been used. Oral metronidazole, e.g., 800-1500 mg/day can be effective. It should be given for up to 4 months to see if it has benefit. Neuropathy is a significant potential side effect.

The combination of certolizumab and methotrexate in a patient with metastatic cutaneous Crohn's disease completely cleared her skin in 6 weeks [Derm Online Journal 21;11].

Additional Pictures

Crohn's Disease of the Skin

A plaque of Sweet's syndrome on the leg developing during a flare of Crohn's disease.
Sweet's syndrome flared by Crohn's disease

References

Painful ulcers of the groin. Indian J Sexually Transmitted Diseases and Aids 2008:29:98-100

Dusky red swelling of the penis. Acta Dermato-Venereologica

An itchy rash. JAAD February 2011 Volume 64, Issue 2, Pages 448–449

Metastatic Crohn's Disease. Derm Online Journal 21;11

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