Prevalence of skin lesions in a sample of Brazilian patients with inflammatory bowel disease

Silveira, Taciana Malosti da; Kroyzanovski, Milena; Purim, Katia Sheylla Malta; Ramos Júnior, Odery; Skare, Thelma; Nisihara, Renato

doi:10.1590/1806-9282.20230165

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Revista da Associação Médica Brasileira

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Sumário

Original Article • Rev. Assoc. Med. Bras. 69 (8) • 2023 • https://doi.org/10.1590/1806-9282.20230165 copy

Prevalence of skin lesions in a sample of Brazilian patients with inflammatory bowel disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Inflammatory bowel diseases may have extra intestinal manifestations such as those affecting the skin. This study aimed to study skin manifestations in a cohort of Brazilian patients with inflammatory bowel diseases.

METHODS:

Epidemiological and clinical data were obtained through a cross-sectional study of 70 inflammatory bowel diseases patients and a control group comprising 50 healthy individuals. All patients were subjected to dermatological examination and photography of skin lesions.

RESULTS:

Out of the 70 inflammatory bowel diseases patients, 50 had ulcerative colitis and 20 had Crohn’s disease. Skin lesions occurred in 95.7% of the inflammatory bowel diseases patients and in 88% of individuals in the control group (p=0.001). Alopecia (p<0.0001), xerosis (p=0.03), striae (p=0.02), and acne (p=0.04) were more common in inflammatory bowel diseases patients than in the control group. Alopecia was more frequent in females (p=0.01) than in males. Two male patients, one with ulcerative colitis and the other with Crohn’s disease, had pyoderma gangrenosum. Erythema nodosum was not observed in both groups.

CONCLUSION:

There was a high prevalence of skin lesions in the Brazilian inflammatory bowel diseases patients. Additionally, alopecia, xerosis, striae, and acne were more common in patients with inflammatory bowel diseases than in those in the control group.

KEYWORDS:
Inflammatory bowel disease; Pyoderma gangrenosum; Alopecia; Skin care

	IBD n=70	Controls n=50	p-value
Alopecia	29 (41.4%)	1 (2%)	<0.0001^* * OR=34.6; 95%CI=4.5–265.7.
Xerosis	19 (27.1%)	5 (10%)	0.03^ OR=3.3; 95%CI=1.1–9.7.
Onychomycosis	13 (18.6%)	12 (24%)	0.50
Tinea pedis	12 (17.1%)	11 (22%)	0.80
Striae	8 (11.4%)	0 (0%)	0.02^§ § OR=13.7; 95%CI=0.77–243.
Acne	7 (10%)	0 (0%)	0.04^§§ §§ OR=11.2; 95%CI=0.66–214.0.
Pilar keratosis	7 (10%)	3 (6%)	Ns
Contactdermatites	6 (8.6%)	2 (4%)	Ns
Folliculitis	5 (7.1%)	1 (2%)	Ns
Weak nails syndrome	5 (7.1%)	0 (0%)	0.07
Seborrheic dermatitis	5 (7.1%)	2 (4%)	Ns
Seborrheic keratosis	4 (5.7%)	8 (16%)	Ns
Common wart	4 (5.7%)	4 (8%)	Ns
Plantar keratoderma	3 (4.3%)	3 (6%)	Ns
Hypertrichosis	3 (4.3%)	0 (0%)	Ns
Pioderma gangrenoso	2 (2.9%)	0 (0%)	Ns
Aphtha	2 (2.9%)	0 (0%)	Ns
Amiloidosis	2 (2.9%)	1 (2%)	Ns
Paronychia	2 (2.9%)	1 (2%)	Ns
Sebaceouscyst	2 (2.9%)	2 (4%)	Ns
Telogeneffluvium	2 (2.9%)	0 (0%)	Ns
Onycholysis	2 (2.9%)	0 (0%)	Ns
Fibroma	2 (2.9%)	0 (0%)	Ns
Herpes lesion	2 (2.9%)	1 (2%)	Ns
Hidrocystoma	2 (2.9%)	0 (0%)	Ns

	Crohn’s disease (n=20)	Ulcerative colitis (n=50)	p-value
Alopecia	10 (50%)	19 (38%)	0.8
Xerosis	6 (30%)	13 (26%)	0.65
Acne	4 (20%)	3 (6%)	0.18
Striae	5 (25%)	3 (6%)	0.03^a a OR=5.2; 95%CI=1.1–24.4).
Onychomycosis	4 (20%)	9 (18%)	0.98
Tinea pedis	5 (25%)	7 (14%)	0.30
	Females (n=45)	Males (n=25)
Alopecia	24 (53.3%)	5 (20%)	0.01^b b OR=4.5; 95%CI=1.4–14.3). n: number.
Xerosis	12 (26.6%)	7 (28%)	0.9
Acne	3 (6.6%)	4 (16%)	0.40
Striae	4 (8.8%)	4 (16%)	0.44
Onychomycosis	6 (13.3%)	7 (28%)	0.19
Tinea pedis	5 (11.1%)	7 (28%)	0.38

	With prednisone (n=7)	Without prednisone (n=63)	p-value
Alopecia	3 (42.8%)	26 (41.2%)	1.00
Xerosis	1 (14.2%)	18 (28.5%)	0.66
Acne	2 (28.5%)	5 (7.9%)	0.14
Striae	1 (14.2%)	7 (11.1%)	1.00
Onychomycosis	0	13 (20.6%)	0.33
Tinea pedis	0	12 (19.0%)	0.34
	With anti-TNF-α (n=14)	Without anti-TNF-α (n=56)
Alopecia	6 (42.8%)	23 (41.0%)	0.90
Xerosis	3 (21.4%)	16 (28.5%)	0.74
Acne	4 (28.5%)	3 (5.3%)	0.02^* * OR=7.06; 95%CI=1.3–36.5.
Striae	3 (21.4%)	5 (8.9%)	0.19
Onychomycosis	2 (14.2%)	11 (19.6%)	1.00
Tinea pedis	2 (14.2%)	10 (17.8%)	1.00
	With azathioprine (n=24)	Without azathioprine (n=46)
Alopecia	10 (41.6%)	19 (41.3%)	0.97
Xerosis	7 (29.1%)	12 (26.0%)	0.78
Acne	5 (20.8%)	2 (4.3%)	0.04^ OR=5.7; 95%CI=1.03–32.5. n: number.
Striae	4 (16.6%)	4 (8.6%)	0.43
Onychomycosis	3 (12.5%)	10 (21.7%)	0.51
Tinea pedis	5 (20.8%)	7 (15.2%)	0.73

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[1] *Corresponding author: renatonisihara@gmail.com; renatonisihara@fempar.edu.br