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P297. Cutaneous Crohn's disease

C. Hackett1, D. Keegan2, D. O'Donoghue3, B. Kirby1

1Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland; 2Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin, Ireland; 3Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin, Ireland

Aims: Cutaneous metastatic Crohn's disease refers to granulomatous inflammation of the skin that is noncontiguous with the gastrointestinal tract. This condition is rare and infrequently documented. Treatment is mainly based on anecdotal reports. We sought to document the clinical features of patients presenting with cutaneous Crohn's disease.

Materials and Methods: A retrospective chart review was performed of patients presenting to our institution with cutaneous Crohn's disease over a 5 year period (January 2005-January 2010).

Results: A total of 4 patients presented, 2 male and 2 female. The average age at presentation was 52 years. The cardinal presenting features included pain and discharge. Perineal and perianal involvement was noted in all cases. One case presented with severe lymphoedema of the scrotum and perineum. Skin biopsies revealed findings consistent with Crohn's. All the patients had long standing severe Crohn's disease and 3 were receiving systemic immunosuppression at the time of presentation for control of their gastrointestinal disease. One case required a diversional colostomy. The majority (3 patients) had active gastrointestinal disease at presentation, which showed response to subcutaneous Adalimumab. All cases required local treatment to the skin lesions. Systemic therapies with infliximab, methotrexate, azathioprine and weekly adalimumab had failed to control the cutaneous disease. The local treatments included intralesional steroid, topical superpotent steroids and a novel approach of injecting adalimumab directly into the cutaneous lesion in one patient with some symptomatic improvement.

Conclusions: We report our experience with this rare condition. There is no standard treatment for cutaneous Crohn's disease. We highlight the novel use of intralesional adalimumab.