Inflammatory Bowel Disease and Associated Skin Manifestations

Abstract

Background: The skin can be an important clinical marker of disease activity and phenotype, and is among most common extraintestinal manifestations of inflammatory bowel disease (IBD). Objective: To determine the frequency and spectrum of cutaneous manifestations in IBD patients and to identify associated clinical parameters. Study Design: Observational cross-sectional study. Place & Duration: Gastroenterology Departments, Tertiary Care Hospitals, Pakistan; October 2025 to March 2026. Methodology: This is an observational study which will be conducted in Gastroenterology Departments of Tertiary Care Hospitals of Pakistan during a six months study period. Non-probability consecutive sampling was employed and a total of 220 patients with confirmed CD and UC were included. All demographic and disease-related data were collected, and then, frequency, type, and clinical associations of the cutaneous manifestations were analyzed with SPSS version 26.0. Independent samples t-test and Chi-square test were used for comparison between Continuous and Categorical variables with a cut-off of p-value as < 0.05 as being statistically significant. Results: Cutaneous changes were found in 54 out of 220 (24.5%) patients most frequently in the form of erythema nodosum (40.7%), followed by aphthous stomatitis (25.9%), pyoderma gangrenosum (14.8%) and psoriasiform changes (11.1%). No differences were found between Crohn's disease patients and ulcerative colitis patients in the frequency of skin involvement (63.0% vs. 37.0% of the affected patients), and the presence of skin involvement was significantly associated with active disease (75.9% vs. 42.8%, p < 0.001), disease duration > 5 years (59.3% vs. 37.3%, p = 0.004), and other extraintestinal manifestations (35.2% vs. 16.9%, p = 0.002). Conclusions: Cutaneous manifestations occur in about 1/4th of patients with IBD and they seem to be linked with phenotype of Crohn's disease, disease activity, its duration and associated extraintestinal involvement, justifying regular dermatological monitoring as a part of comprehensive management of IBD patients