Cutaneous Crohn's disease

Question 1

What are the common skin findings a/w Crohn’s disease?

Answer 1

Erythema nodosum

- PG (UC > Crohns)

• pyostomatitis vegetans

- EBA (IBD is most common cause of EBA)

- acrodermatitis enteropathica-like syndrome due to zinc deficiency

Every Pope Probably Eats Apples (if they have Crohns)

Question 2

Is cutaneous crohns more commonly a/w colorectal or small intestinal disease?

Answer 2

Colorectal

Question 3

Genital Crohns presents as:

Answer 3

labial or scrotal edema + erythema/ulceration/fissures

Question 4

Perianal crohns presents as:

Answer 4

ulcers, sinus tracts, fissures, or eroded vegetating plaques

• frequently extende to perineum, buttocks, abdomen, abdominal surgical ostomy sites

Question 5

Oral Crohn’s presents with:

Answer 5

cobblestoning of buccal mucosa, pyostomatitis vegetanns, cheilitis granulomatosa (see photo), aphthous ulcers, gingival nodules

Question 6

Extragenital (“metastatic”) Crohns disease presents as:

• most common location?

Answer 6

• dusky red papules/plaques that ulcerated with undermined edges, fistulas, draining sinuses and scarring

lower extremities/soles are most common, followed by abdomen/trunk

Question 7

Histopath of Cutaneous Crohns:

Answer 7

• Non-Caseating tuberculoid granulomas w/ inflammatory rim of lymphocytes in superficial and deep dermis; frequent Langerhans GCs

Question 8

First line treatment for cutaneous crohns:

Answer 8

• Oral metronidazole, topical/intralesional steroids and TCI’s
• severe cases: oral steroids, sulfasalazine, MTX, MMF, cyclosporine, azathioprine, TNFai,