Ulcerative Colitis is marked by inflammation that presents through several gastrointestinal symptoms, as well as in other areas of the body including the skin, joints, mouth, and eyes. Swollen and painful areas of skin are common and affect up to 15 percent of individuals with UC. In general, skin irritation and rashes will get worse during a flare and resolve during periods of remission. These rashes oftentimes fluctuate in-line with the inflammation throughout your entire body.
While most skin irritation and rashes are caused by Ulcerative Colitis inflammation, general UC symptoms do not always cause the irritation and rashes. Ulcerative Colitis medications may cause skin issues as a side effect. Additionally, lack of nutrients may present as skin irregularities. It is important to work with your medical team to determine the cause of your skin problems.
Skin Irritation Linked to Ulcerative Colitis
There are numerous skin conditions associated with Ulcerative Colitis, many of which are caused by auto-immune functions.
Erythema nodosum is the most common skin problem associated with UC. It usually presents at the start of a flare or just before a flare. The key signs of Erythema nodosum are tender red nodules on your arms and legs. These (sometimes) painful bumps develop in the layer of fat under the skin. Sometimes Erythema nodosum may also appear as bruises on the skin. This condition affects between three and ten percent of Ulcerative Colitis sufferers and is more common in women.
Pyoderma gangrenosum is the second most common skin issue seen in individuals with Ulcerative Colitis and affects about two percent of individuals with UC. Pyoderma gangrenosum starts as a small cluster of blisters that can look like pimples or bug bites. Over time, these abrasions turn into larger, deeper, pus-filled ulcers with blue or purple edges. These ulcers are painful, cause scarring, and may become infected if not kept clean. Pyoderma gangrenosum generally presents on the skin and ankles, but can also develop on the arms. Researchers believe Pyoderma gangrenosum is be caused by a dysfunction in the immune system, which may also be linked to Ulcerative Colitis.
Sweet’s syndrome is a rarer condition that presents as small red or purple bumps. The tender bumps spread into painful lesions on the hands, face, neck, upper arms, and upper legs. This condition is also associated with flares. Sweet’s syndrome may also appear like Erythema nodosum, but your doctor will be able to tell the difference.
Bowel-associated dermatosis-arthritis syndrome (BADAS)
Bowel-associated dermatosis-arthritis syndrome (BADAS) occurs in individuals with Ulcerative Colitis, as well as individuals who have recently undergone intestinal surgery. It is believed to be caused by bacterial overgrowth that triggers inflammation. BADAS presents as small, painful bumps that grow into pustules on the upper chest and arms. The lesions can also appear bruise-like on the legs like Erythema nodosum or Pyoderma gangrenosum.
Psoriasis is also caused by immune dysfunction and affects about six percent of individuals with UC. With psoriasis skin cells build up causing scaley, raised patches of skin in various areas of the body.
Vitiligo is another immune disorder. This condition causes the loss of pigment in skin cells and leads to white patches on various areas of the body.
Mouth sores are common during a Ulcerative Colitis flare and may present before a Colitis diagnosis. Mouth issues may include painful ulcers, swelling of the tongue, lips, or gums, or dry, cracked lips.
Anal fissures may occur with UC. Fissures are small tears in the skin that may crack and bleed and/or cause pain and itchiness. They are common in the anal canal with Ulcerative Colitis and the associated gastrointestinal symptoms.
Acne, specifically cystic acne, may be linked to Ulcerative Colitis. Cystic acne, unlike other forms of acne, causes painful cysts under the surface of the skin.
Hives are itchy, red rashes that are chronically seen with Ulcerative Colitis. Hives may also be caused by a reaction to a medication used to treat Ulcerative Colitis.
Treating Skin Conditions
No matter the cause of your skin condition, it is best to talk with your doctor about your skin concerns. He or she can help you identify the cause of the issue and develop a treatment plan.
If you are experiencing a skin condition associated with a UC flare, the best way to manage your skin is to manage the flare. Reducing inflammation in your intestines will also reduce the inflammation across 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 to reduce inflammation
- Eating a well-balanced diet for gut and skin health
- Keeping irritated skin clean to avoid infection
- Covering irritated skin with bandages to keep clean
- Taking over-the-counter pain relievers as recommended by your doctor
If you’re having trouble managing your Ulcerative Colitis, 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.