Occurrence of skin manifestations in patients of the Swiss Inflammatory Bowel Disease Cohort Study

PLoS One. 2019 Jan 25;14(1):e0210436. doi: 10.1371/journal.pone.0210436. eCollection 2019.

Abstract

Background/aims: Extraintestinal cutaneous manifestations of IBD represent a severe disease complication and an early and accurate treatment might positively influence the disease course. Using the patient collective of the Swiss IBD Cohort Study (SIBDCS), we analysed epidemiological as well as clinical factors being associated with the onset of pyoderma gangrenosum, erythema nodosum and aphthous ulcers in IBD patients.

Methods: We included 3266 SIBDCs patients, 1840 with Crohn's disease (CD) and 1426 with ulcerative colitis (UC) or IBD unclassified (IBDU) and analysed the association of cutaneous manifestations with age, age at diagnosis time, type of disease, gender, family history, HLA-allotype, smoking, intestinal disease activity, therapy and other extraintestinal manifestations (EIM).

Results: 354 CD patients and 136 UC/IBDU patients presented with skin manifestations at any time during their disease course. In both, CD and UC, female gender and younger age at IBD diagnosis were significantly associated with extraintestinal skin manifestations. For CD, we also detected a positive family history as associated factor. As an indicator of more intensive intestinal disease activity, patients with cutaneous manifestations of IBD needed more frequently therapy with antibiotics, steroids, immunomodulators and anti-TNF. Multivariate analysis revealed female gender, younger age at diagnosis and presence of other extraintestinal manifestations as factors being associated with skin EIM in IBD patients and anti-TNF as well as immunomodulatory treatment in CD patients.

Conclusion: Our results suggest that young females with a positive family history of IBD might be at increased risk for the onset of skin manifestations and require a careful screening for such complications.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cohort Studies
  • Colitis, Ulcerative / complications*
  • Crohn Disease / complications*
  • Erythema Nodosum / diagnosis*
  • Erythema Nodosum / drug therapy
  • Erythema Nodosum / etiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pyoderma Gangrenosum / diagnosis*
  • Pyoderma Gangrenosum / drug therapy
  • Pyoderma Gangrenosum / etiology
  • Risk Factors
  • Sex Factors
  • Switzerland
  • Young Adult

Grants and funding

This work was supported by research grants from the Stiftung Experimentelle Biomedizin to MS, the Promedica Foundation to MS, the Swiss National Science Foundation to MS [Grant No. 314730_166381] and to GR for the Swiss IBD Cohort [Grant No. 3347CO-108792], the Promedica & Bruno Bloch Foundation and by the HSM-2 grant “Immunvermittelte Erkrankungen” from the Kanton of Zurich, Switzerland to AN. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.