Understanding the skin problems associated with chronic inflammatory bowel disease (IBD)

What is IBD? 

Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis (UC), is a condition in which the lining of part of the digestive tract becomes inflamed as a result of dysregulation of the intestinal immune system.

As well as the well-known intestinal symptoms such as abdominal pain, diarrhoea and rectal bleeding, IBD can also cause skin problems, which are part of extra-intestinal manifestations (EIM), like eye disorders. According to statistics, these symptoms are more frequent when the colon is affected.

Different types of skin conditions, called dermatoses, are therefore common among IBD sufferers.

What are the most common skin problems caused by IBD? 

Skin conditions that develop in people suffering with chronic inflammatory bowel disease (IBD) can be varied and include skin problems induced directly by IBD, those associated with IBD or caused by the use of IBD treatments (e.g. anti-TNFα), or skin conditions linked to various deficiencies due to malabsorption of nutrients.

Here is a list of IBD-related skin conditions: 

Skin conditions specific to IBD

These conditions are not necessarily dependent on the course of IBD and may even appear before the digestive symptoms, which can contribute to earlier diagnosis of IBD. 

Granulomatous lesions

These lesions are characterised by the formation of inflammatory nodules in the intestinal wall, which consists mainly of the immune cells and scar tissue, contributing to fibrosis and long-term complications. They are defined by a giganto-cellular granuloma without caseous necrosis. 

Anoperineal lesions 

Clinical aspects of these lesions are rather varied, ranging from perianal fissures, deep linear ulcerations with sharp edges known as "stab wounds", digging ulcerations that can lead to destruction of the anal sphincter, to abscesses complicated by anal, perineal or recto-vaginal fistulas.

Vulvar lesions

They include deep vulvar linear ulcers or painful labial oedema. Male localisations are rarer. 

Orofacial lesions

There are also ulcerations, furrows in the gums, ulcerations that look like canker sores, gingival hypertrophy and hyperplasia of the inside of the cheeks (abnormally large volume of organic tissue).

Skin lesions

These lesions are quite rare. They include facial erythema, acne nodules and pseudo-erysipelas (skin infections). 

Reactive skin conditions

These lesions are often the result of chronic inflammation and manifest themselves as tissue changes such as oedema, necrosis and epithelial hyperplasia, which can lead to ulcerations and fistulas. The most common conditions are: 

Erythema nodosum

A skin manifestation characterised by painful, red inflammatory nodules, often located on the lower limbs.

Mouth ulcers 

A condition characterised by superficial ulcers in the oral cavity.

Pyoderma gangrenosum 

A rarer but serious skin condition, characterised by deep, painful ulcers with purplish, necrotic margins, requiring urgent medical intervention to prevent severe complications.

Reactive lesions associated with IBD can also include neutrophilic dermatitis (ND), Sweet's syndrome (SS), arthrocutaneous syndrome, pyostomatitepyoderma vegetans (PPV) and aseptic abscesses.

Skin conditions caused by deficiencies

These conditions are the result of intestinal malabsorbtion and chronic inflammation, leading to nutritional deficiencies. Possible conditions include:

Flollicular hyperkeratosis 

This is the build-up of keratin around the hair follicles, leading to the formation of small, rough bumps.

Bruises 

Skin lesions resulting from the rupture of blood vessels under the skin, often observed in IBD patients due to coagulation disorders and vascular fragility associated with chronic inflammation.

Seborrhoeic dermatitis

It is an inflammation of the skin characterised by red, scaly and sometimes oily patches, which can occur as a result of changes in the composition of skin lipids and an altered immune response. 

Skin conditions associated with IBD 

These conditions are inflammatory or autoimmune diseases with genetic predisposing factors that are sometimes the same as those of IBD. They develop independently of IBD. Here are a few examples:

Epidermolysis bullosa acquisita 

A rare autoimmune skin condition characterised by the formation of bubbles and blisters on the skin and mucous membranes.

Chronic skin conditions 

There is a number of persistent and recurrent skin conditions, often associated with IBD. These conditions may often require long-term management and may be exacerbated by the inflammation and immune imbalances associated with IBD.

Such chronic skin conditions include:

• Psoriasis, 
• Atopic dermatitis (eczema), 
• Dermatitis herpetiformis, 
• Lichen planus, 
• Dermatomyositis, 
• Rosacea, 
• Vitiligo 
• Alopecia (hair loss), 
• Scleroderma, 
• Gougerot-Sjögren syndrome, 
• Systemic lupus erythematosus (SLE), 
• Vasculitis, 
• Hidradenitis suppurative. 

One study revealed that people suffering from atopic dermatitis (eczema) are 34% more likely to develop IBD compared to those who do not have this condition.

Skin conditions caused by treatments 

The use of certain treatments such as anti-Tumor Necrosis Factor (TNF) has improved the management of IBD. However, side effects, particularly the ones affecting the skin, especially psoriasiform eruptions, were rapidly described in patients treated with these molecules.

Psoriasiform eruptions are skin manifestations similar to psoriasis, characterised by thick, scaly red patches on the skin.

How can you take care of your skin if you suffer with IBD? 

Depending on the case, the various skin problems linked to or associated with IBD either heal with treatment of the digestive tract or require local treatment.

The management of skin problems in IBD patients requires a multidisciplinary approach, often involving a gastroenterologist and dermatologist working in close collaboration. IBD patients also have a slightly increased risk of developing skin cancers.

Here are the recommendations for looking after your skin when you have IBD:

• Control the inflammation 

Systemic anti-inflammatory drugs, such as corticosteroids and immunosuppressants, can be used to reduce inflammation and alleviate skin symptoms.

• Have a gentle skincare routine

It is recommended to adopt a gentle skincare routine suited to your skin type. This can include the use of gentle cleansers, non-irritating moisturisers and sunscreens to avoid exacerbating skin problems.

• Avoid the known triggers 

Knowing how to identify and avoid known triggers for skin problems can help minimise flare-ups. The most common triggers include stress, food allergies, certain medications and skin irritants.


People with IBD who are taking or planning to take immunomodulatory drugs or biological agents should be annually screened for skin cancer, use sunscreen and wear protective clothing.

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