Crohn’s Disease is marked by inflammation that presents throughout the gastrointestinal symptom, as well as in other locations across the body. Crohn’s symptoms that appear outside the gastrointestinal tract are known as extra-intestinal manifestations and occur in up to 40 percent of individuals with inflammatory bowel disease (IBD).
In general, extra-intestinal manifestations including rashes and skin irritation will get worse during a flare and resolve during periods of remission. These rashes oftentimes fluctuate in-line with the inflammation throughout your body.
While most skin irritation and rashes are caused by Crohn’s Disease inflammation, general IBD symptoms do not always cause irritation and rashes. Crohn’s medications may cause skin issues as a side effect. Additionally, lacking specific nutrients may present as a rash, so it is important to work with your medical team to determine the cause of your skin problems and the appropriate associated treatment.
Skin Issues Linked to Crohn’s Disease
Erythema nodosum (EN)
Erythema nodosum (EN) is the most common skin problem associated with Crohn’s. It usually presents as red, painful bumps that appear on the shins, ankles, and arms. Over time the red bumps will turn purple. Some individuals will also experience fever and joint pain with EN. Up to 15 percent of people with IBD experience EN.
Pyoderma gangrenosum (PG)
Pyoderma gangrenosum (PG) is a rare skin condition but is seen more often in individuals with IBD. Symptoms of PG include small red bumps that look like insect bites on the shins and ankles, and grow into large, open sores. Unfortunately, PG often causes scarring. Up to 5 percent of people with IBD experience PG.
Sweet’s Syndrome is a rarer condition that presents as small red painful bumps on the arms, neck, head, and torso. The bumps may eventually grow together to form one large plaque. This condition also often coincides with Crohn’s flares.
Leukocytoclastic vasculitis, small blood vessels inflammation in the legs, causes small red and purple spots on the legs. This condition can be itchy or painful but will likely heal within a few weeks.
Epidermolysis bullosa acquisita
Epidermolysis bullosa acquisita causes blisters on injured skin, specifically on the hands, feet, knees, elbows, and ankles. This condition is an auto-immune disorder and can be treated with medications that reduce inflammation and suppress the immune system. It is more common in people who have had Crohn’s Disease for years.
Psoriasis is caused by immune dysfunction and is more common in individuals with IBD. With psoriasis, skin cells build up, causing scaly, raised patches on the skin in various areas. These patches are called plaques.
Vitiligo is another immune disorder. This condition causes pigment loss in skin cells and leads to white patches on various areas of the body.
Canker sores inside the mouth are common during Crohn’s flares. These sores often cause pain when eating and talking. Often, canker sores are caused by diminished vitamin or mineral status as a result of decreased nutrient absorption. Managing a flare will help resolve this issue.
Anal fissures may occur with Crohn’s. Fissures are small tears in the skin lining the anus that may crack and bleed and/or cause pain and itchiness.
Acne is often seen with Crohn’s disease but is triggered by the steroids used to control symptoms, not the disease itself. After your prescribed doses of steroids, acne will likely clear.
Skin tags are harmless flesh-colored growths often seen in the armpits, groin, or other areas where skin rubs against itself. The tags also often develop around hemorrhoids or anal fissures in individuals with IBD. Keeping the area around the anus clean helps prevent future pain and irritation.
Metastatic Crohn’s Disease
Metastatic Crohn’s Disease is a rare skin issue linked to Crohn’s. It often presents as plaques on the legs, vulva, penis, torso, and face, which may develop before Crohn’s is even diagnosed.
Treating Skin Conditions
No matter you skin condition’s cause, it is best to talk with your doctor about your skin concerns. He or she can help you identify the cause and develop a treatment plan.
If you are experiencing a skin condition associated with a Crohn’s Disease flare, the best way to manage your skin is to manage the flare. Reducing inflammation in your gastrointestinal tract will also reduce inflammation throughout the rest of your body, including your skin.
Some methods to help improve skin irritation during a flare include:
- Taking medication recommended by your doctor, including corticosteroids, immunosuppressants, or antibiotics
- Changing doses or discontinuing medications, as recommended by your doctor
- Taking vitamin supplements, as recommended by your doctor
- Undergoing surgery to treat Crohn’s disease
If you’re having trouble managing your Crohn’s, we recommend working with a dietitian who can help you obtain and sustain remission.
Kaitlyn Willwerth is a Registered Dietitian at OnPoint Nutrition. Kaitlyn's work focuses on providing individualized health and lifestyle coaching and, most importantly, support. She is a Certified LEAP Therapist and has also completed the Monash University 'Low FODMAP Diet for IBS' online training course for health professionals.