Cutaneous and ocular manifestations of IBD

Authors G.P. Karamanolis.


Cutaneous and ocular manifestations reflect the systemic
nature of the inflammation seen in inflammatory bowel disease
(IBD). These manifestations occur more commonly in
association with active IBD. Thus, they may respond to therapy
for bowel disease, but may require this at an intensity
out of proportion to that needed for the bowel. Corticosteroids
are considered to be the first line treatment, whereas
in cases refractory to steroids or with, the presence of sideeffects,
immunosuppressive drugs offer an alternative option.
Recently, anti-TNF has been proposed as an effective
treatment for extraintestinal manifestations of IBD refractory
to conventional therapies, especially for pyoderma gangrenosum.
However, the optimal form of treatment of extraintestinal
manifestations has yet to be established. Cutaneous
and ocular manifestations are well recognized complications
of inflammatory bowel disease (IBD) and reflect
the systemic nature of the inflammation seen in these conditions
(1). Although the reported prevalence of these complications
in IBD varies, it is well known that extra-intestinal
manifestations occur preferiantally in patients with
disease of the colon and they may rarely complicate disease
confined to the small bowel. Cutaneous complications
are reported in 6-15% of Crohns disease patients,1-3 and in
1-9% of ulcerative colitis (UC) patients,4 while acute ocular
inflammation in up to 10% of Crohns and 5% of UC patients.
1-2 Both cutaneous and ocular complications are said
to occur more commonly in association with active IBD,
and often coexist with other extra-intestinal manifestations.5
Erythema nodosum (EN) is the most common form of cutaneous
manifestations followed by pyoderma gangrenosum and Sweets syndrome. Ocular inflammation of IBD is predominantly
anterior in contrast to other systemic inflammatory
disorders; uveitis, iritis, episcleritis are the commonest
forms of ocular complications in patients with IBD.