Gastrointestinal Disease

Diseases associated with Inflammatory Bowel Disease

  • Inflammatory Bowel Disease
    • Fissures and fistulas
    • Oral Crohn’s Disease
    • Erythema Nodosum
    • Epidermolysis bullosa acquisita
    • Pyoderma Gangrenosum
    • Pyoderma Vegetans
    • Pustular vasculitis or bowel-associated dermatitis-arthritis
    • Chronic aphthous ulcers
    • Polyarteritis nodosa
    • Psoriasis
    • Urticaria
 
Cutaneous Crohn Disease
  • Mecanismo das lesões cutâneas no Crohn
    • Non caseating granulomas in dermis → edema, swelling, papulonodules
    • If very big may cause compromise in epidermis leading to ulceration
    • Lesions may be non-specific in morphology patterns
  • Epidemiologia
    • 20% of patients will have skin findings as presenting symptom of the disease
  • Types
    • Contiguous (30%)
    • Metastatic (10%)
  • Contiguous
    • Swelling of labia majora
    • Vulvar and perianal erythema
    • Swelling with erosions
    • Inflammation and edema of the penis
  • Metastatic Crohn Disease
    • Knife like ulcerations in the genital region
    • Non contiguous extension of GI granulomas into the skin
    • Granulomas may lead to deep inflammatory fissures discribed as “knife like fissures”
    • May mimick severe Hidradenitis Supurativa - look for involvement of follicle units and look at other locations
    • Rare manifestation to have vasculitis in Crohn’s (Chron’s is usually granulomatous not vasculitic, but extraintestinal Crohn’s is the exception, may be vasculitic)
    • On lower extremities, mimicks PAN and EN
      • Both which can occur in conjuntion with Crohn’s
    • Can be septal or lobular
      • NON-caseating (distinguishes from EI)
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Always think of Crohn when there is external genitalia swelling and inflammation, and infectious causes are ruled out
Oral lesions in Crohn
  • 5-20% patients with Crohn’s disease
  • Cobblestoning of bucal mucosa
  • Tiny gengival nodules
  • Small aphtae like ulcers
  • Linear ulcerations in the mandibular vestibule
  • Angular cheilitis
  • Pyostomatitis vegetans
  • Gengival hyperplasia
  • Chelitis granulomatosa
  • Diffuse oral swelling
  • Indurated fissuring of the lower lip
 
Pyoderma Gangrenosum
  • Classic ulcerative form or peristomal form
  • May not reflect activity of bowel disease
 
Suppurative pyostomatitis vegetans
  • More common in ulcerative colitis
  • Sterile pyoderma of labial and bucal mucosa
  • Pyoderma like pustules that coalesce in bullous lesions filled with purulent material
  • Aseptic
 
Peristomal Pyoderma Gangrenosum
  • Infrequent cause of peristomal dermatitis (irritant or allergic contact dermatitis are the most common)
 
Erythema Nodosum (Ver paniculites)
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Erythema Nodosum

Diseases associated with GI hemorrhage

  • Hereditary hemorrhagic telangiectasia
  • Blue rubber bleb nevus
  • Pseudoxanthoma elasticum
  • Ehlers-Danlos type IV
  • Gardner syndrome - adenomatosis poliposis → 100% progression to cancer by age 30yo
  • Peutz-Jeghers syndrome - hamartomatous polyps, increased risk of pancreatic cancer
  • Cowden syndrome
  • Muir-Torre syndrome - colon cancer
  • Cronkhite-Canada syndrome - benign GI polyps, enteropathy and bleeding
  • Vasculitis
  • Malignant atrophic papulosis (Degos) - may lead to intestinal perforation, peritonitis, death
  • Scurvy
  • Kaposi’s sarcoma
  • Inflammatory bowel disease
 
Melena and epistaxis - most common presenting signs

Dermatologic findings in Hepatitis B and C

  • Cryoglobulinemia mixed - type II or III (C>B) - small and medium vessel vasculitis
  • Urticarial vasculitis
  • Polyarteritis nodosa (classic: B; cutaneous: C)
  • Livedo reticularis (C)
  • Acute urticaria (A>B>C)
  • Porphyria cutanea tarda (B,C)
  • Pruritus (B, C>A)
  • Lichen planus, especially oral erosive (C)
  • Sarcoidosis with interferon or ribavirin treatment (C>B)
  • Necrolytic acral erythema (C)
  • Gianotti-Crosti syndrome or papular acrodermatitis (B worldwide; EBV in USA)
  • Erythema multiforme (B,C)
  • Erythema nodosum (B>C)
Necrolytic Acral Erythema associated with hepatitis C
  • Hyperkeratotic plaques
  • Dorsal feet and hands
 
Other associations
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