Can IBD Cause Skin Problems?

Although inflammatory bowel disease (IBD) mainly affects the digestive system, people with IBD are often frustrated to find that symptoms can affect the whole body. For example, IBD often causes aches and fatigue, and it can lead to more specific problems with the mouth, skin, eyes, and internal organs. These kinds of symptoms are called extraintestinal manifestations (EIM), and while some flare up when IBD is already active, others are harder to predict. Because of this, it can be hard to know whether a new symptom is related to IBD, or whether it’s something else entirely.

If you’ve been diagnosed with IBD and are having skin problems, the two might be related: up to 40% of IBD patients experience EIMs, and up to 20% have problems with their skin, specifically. Luckily, getting the intestinal inflammation under control often helps patients with all of their symptoms—not just the digestive ones. That’s why it’s so important to work toward controlling flare-ups. 

Can IBD Cause Skin Problems?

IBD can cause skin problems ranging from minor bumps to more serious rashes. In fact, skin problems are among the most common EIMs among people with IBD. Some of these problems come from the disorder itself, but others are side effects of treatment or come from malnutrition. If you are experiencing new skin symptoms, you should let your doctor know so that you can find a way to manage them.

Since skin problems often cycle with intestinal inflammation, minimizing flares can also minimize your skin-related symptoms. Combined with medical treatment, a proper diet is important for managing IBD flare-ups, and getting your nutrition under control can help you reach remission. Still, some conditions might require more specific treatment, or they might be linked to your IBD medications, so it’s important to keep your doctor involved. 

Skin Problems Linked to IBD

 A number of skin problems are related to IBD, including both common and rare conditions. Some of the more common skin problems linked to IBD include:

• Erythema Nodosum: Erythema nodosum means “red bumps,” and as its name suggests, the condition causes sensitive red bumps on the shins, ankles, and arms. The rash usually appears during a flare, or just before one starts, so managing inflammation is the most important treatment. This is one of the most common skin-related EIMs, occurring in up to 10% of people with IBD.
• Pyoderma Gangrenosum: Like erythema nodosum, pyoderma gangrenosum usually occurs on the shins, ankles, or arms, but it causes blisters and ulcers rather than bumps. This condition is more common among people with ulcerative colitis, but it can also occur in Crohn’s disease. Managing the underlying IBD can help eliminate the blisters, but specific treatment is often necessary, especially if the blisters become ulcers.
• Skin Tags: Skin tags are relatively benign skin flaps that remain after anal swelling decreases. Although they are not painful on their own, they can become irritated and tender, especially during flare-ups.
• Enterocutaneous Fistulas: A fistula is a connection between two body parts that shouldn’t be connected. Fistulas between the intestine and the skin can occur in almost a third of people with Crohn’s disease, although they are less common in those with ulcerative colitis. Fistulas can also happen after surgery. Treatment involves closing or draining the opening to prevent infection.
• Anal Fissures: People with IBD often develop uncomfortable tears in their anal tissue as a result of their other symptoms. Doctors often recommend topical treatment and warm baths to soothe irritation.
• Aphthous Stomatitis: You likely know aphthous stomatitis by a different name: canker sores. During a flare-up, it’s very common to develop these irritating ulcers along the gums or the tongue. Controlling IBD helps reduce the frequency of canker sores, but your doctor might also recommend mouthwashes.
• Sweets Syndrome: This rare condition causes fever and tender, red lesions across the upper body. It is more common among women.
• Acrodermatitis Enteropathica: Chronic diarrhea can lead to zinc deficiency, which causes a flaky rash on the hands, feet, face, and perineum.
• Pyoderma Vegetans: Abnormal immune activity associated with ulcerative colitis might cause tender blisters and plaques across the groin and armpits. 
• Vasculitis: Vasculitis refers to blood vessel inflammation, and it can occur with abnormal immune activity. People with vasculitis may experience raised, reddened skin and ulcers while their IBD is active.
• Epidermolysis Bullosa Acquista: People with chronic Crohn’s disease occasionally develop this skin condition, which causes blisters and scarring when the skin is bumped or scratched. The condition is caused by an overactive immune system, and it is most common in those who have experienced Crohn’s symptoms for many years.

Whether or not your IBD is currently active, unexplained rashes, bumps, or blisters can be a warning sign that your symptoms are getting worse, or that you are about to experience a flare-up. When in doubt, talk to your doctor about your concerns.

What to Do About IBD-Related Skin Problems

Although it’s always frustrating to experience new symptoms, the good news is that most skin problems related to IBD are completely treatable. 

The most important first step is to talk to your treatment team, including your doctor, to find out what’s causing the problem. Depending on the condition, your doctor might recommend a prescription or over-the-counter steroid creams to counter redness and itching. You might also need to change your medications, if you’re having a negative reaction, or if they aren’t helping as much as they should.

It can also be helpful to loop in a dietitian. Some skin problems on the list aren’t caused by IBD itself, but by nutritional deficiencies, which are more common in people with IBD. A dietitian can help you find and fix gaps in your diet that might be making symptoms worse. Good nutritional guidance can also help you reduce the frequency and severity of your flare-ups. Many skin problems get worse when your other symptoms are worse, so an effective management strategy is your best tool to defend against them. 

Having helped countless IBD patients take control of their diet, we’ve seen first-hand how challenging it can be to deal with new or worsening symptoms. If you’re feeling overwhelmed by your symptoms, or by all the conflicting information about how diet affects IBD, learn how we can help, or contact us with our specific questions. Through our evidence-based eating strategies, our clients achieve huge improvements in their symptoms, all while taking steps toward full symptom remission.