Introduction: There are several extraintestinal manifestations of inflammatory bowel disease (IBD) including cutaneous. Furthermore, new biologics have been also associated with cutaneous side effects. However, the prevalence of extraintestinal manifestations in patients with IBD and those who receive anti-tumor necrosis factors (anti-TNFs) have not been extensively studied. Using a large database, we sought to describe the rates of selected cutaneous manifestations of IBD as long as adverse effects of anti-TNFs.
Methods: We queried a multi-institutional database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 US healthcare systems was surveyed. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of inflammatory bowel disease between 2017-2021 was identified. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp). For all analyses, a 2-sided P value of < 0.05 was considered statistically significant.
Results: Of the 34,277,840 individuals in the database, 142,890 (0.42%) and 165,960 (0.48%) had a diagnosis of ulcerative colitis (UC) and Crohn’s disease (CD) respectively. Baseline characteristics of patients with IBD and control group are shown in Table 1. Compared to the non-IBD group, patients with a history of IBD had a higher rates of multiple skin conditions including erythema nodosum, pyoderma gangrenosum, sweet syndrome, psoriasis, lichen planus, alopecia, eczema, vitiligo, bullous disease, and skin cancers. Among IBD patients, those who are on anti-TNFs and immunomodulator (IM) had higher rates of herpes/zoster and candida infections, lichen planus, alopecia, eczema and melanoma and non-melanoma skin cancers compared to anti-TNFs alone (Table 3).
Discussion: In this large database, we found a higher risk association between IBD and multiple skin conditions including skin cancers. Interesting, IBD patients treated with anti-TNFs had double rates of melanoma and non-melanoma skin cancers. Further epidemiological studies are required to validate these findings and increase attention to adequately screening for skin cancers and dermatology referral while taking care of IBD.
