How Crohn’s Disease Affects Your Skin

Some of these skin conditions can get worse in winter, because freezing temperatures and dry indoor air can leave the skin parched. And because Crohn’s — and many of the medications that treat it — can weaken the immune system, people with the disease may also be more susceptible to skin infections, says Amanda Moon, MD, a pediatric dermatologist at Children’s Hospital of Philadelphia.

Here are some of the more common Crohn’s-related skin conditions — along with some of the rarer ones — plus, how to treat them.

Erythema Nodosum

Pyoderma Gangrenosum

“Although these ulcers look infected, they’re usually not, so antibiotics don’t help,” says Dr. Winterfield. Pyoderma gangrenosum isn’t preventable, but avoiding skin trauma may decrease the risk. Treatment may require high doses of steroids.

Aphthous Stomatitis

This skin condition causes small mouth ulcers, also called canker sores. They commonly occur in people when intestinal symptoms flare up, then disappear when those symptoms subside. They are painful, sensitive, and usually form between the gums and lower lip or on the tongue.

Eating a balanced Crohn’s diet may help prevent canker sores, but to alleviate the symptoms, you may want to try using a medicinal mouthwash.

Skin Tags

Rare skin conditions that are associated with Crohn’s include:

Acrodermatitis Enteropathica

“This skin condition causes a pink, scaly rash that usually appears around the mouth or anal area,” says Winterfield. It’s caused by a deficiency in zinc, which, for people with Crohn’s disease, can be lost during bouts of diarrhea. Replacing zinc in the diet makes the rash go away.

Epidermolysis Bullosa Acquisita

The condition is rare but has been reported in scientific literature as a complication of Crohn’s disease. It causes blisters on the hands, elbows, knees, and feet, according to the National Institutes of Health’s Genetic and Rare Diseases Information Center. It also occurs in other diseases of the immune system. Treatment may require steroids and other immunosuppressant drugs.

• Sulfasalazine, a drug used to block inflammation in Crohn’s, may cause an allergic skin rash, hives, or itching. “In most cases, this medication can be replaced with another that does not contain [sulfonamides],” says Winterfield.
• Steroids are an important medication used to block inflammation in Crohn’s. But long-term steroid use can cause skin thinning and loss of skin color, as well as aggravate acne.

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• Anti-tumor necrosis factor (TNF) drugs, a type of biologic medication used for Crohn’s disease, among other conditions, may cause a skin rash at the injection site. “Psoriasis is another immune disease that may be linked with Crohn’s, and anti-TNF drugs may trigger psoriasis in some people,” notes Winterfield.

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Dermatologists will often work closely with gastroenterologists to determine a therapy that treats Crohn’s but doesn’t exacerbate skin issues, Moon says.

“It is important to remember that many of these skin conditions occur in people who don’t have Crohn’s disease, and also that people with Crohn’s disease can have skin conditions that aren’t caused by Crohn’s,” says Winterfield.

Learning as much as you can about Crohn’s and working closely with your doctor to keep your Crohn’s under control is the best way to prevent complications. Always check in with your doctor if you develop any new symptoms, including ones that have nothing to do with digestive issues.

The Takeaway

• People with Crohn’s are also susceptible to skin conditions, which are the most common extraintestinal complications of the disease after arthritis.
• Some of the more common skin conditions associated with Crohn’s disease include erythema nodosum, pyoderma gangrenosum, and aphthous stomatitis.
• Some of the rarer skin conditions associated with Crohn’s disease include acrodermatitis enteropathica and epidermolysis bullosa acquisita. Sometimes, skin conditions can also be triggered by medications such as sulfasalazine, steroids, and anti-tumor necrosis factor (TNF) drugs.

Additional reporting by Ashley Welch.