P683 Skin lesions in patients with inflammatory bowel disease from southern Brazil: an epidemiologic study
H. Amarante*1, G. Reis1, A. Szczypkovski1, G. Quadros1, M. Peretti2, M. Mukai2
1Hospital de Clínicas of Federal University of Parana, Gastroenterology, Curitiba, Brazil, 2Hospital de Clínicas of Federal University of Parana, Dermatology, Curitiba, Brazil
Crohn’s disease (CD) and ulcerative colitis (UC), like many immunologically-mediated conditions, have other organs than the primary site affected: joints, eyes, biliary tract, skin and others. This study objective is: 1) Describe types and prevalence of skin lesions in patients with IBD attending to a reference Centre in southern Brazil. 2) Search for correlation of skin lesions with type of IBD, medications and inflammatory activity.
Prospectively, patients with history of documented previous skin lesions or presence of lesion during the medical examination were selected. Laboratory and clinical data were collected and patients underwent a specialised dermatologic evaluation. Biopsy was done when necessary. Statistical analysis was performed.
354 patients were studied – median age of 45.15 years with 57% females, most of them Caucasian. Sixty (16,9%) presented some kind of skin manifestation, distributed in specific (6%), reactive (8%), related to medications (3%), aggravated by immunosuppression (11%), not related to IBD (47%),the most common being seborrheic dermatitis and seborrheic keratosis, and neoplasia and/or sun damage related(25%), with a total of 88 different skin lesions. All descriptive data were converted in graph. Twenty percent of these 60 patients (12) presented directly IBD related skin lesions, 4 were pyoderma gangrenosum. Statistical analysis has shown that patients with specific IBD lesions (metastatic Crohn, aphthous stomatitis and perianal lesions) correlated with higher blood levels of C-reactive protein and platelets comparing with other lesions (p = 0.016 e p = 0.008, respectively). DC, compared with UC, had more lesions aggravated by immunosuppression (p = 0.046), but only CD was treated with anti-TNF. Comparing this study with historical population average, it was also shown statistical difference in prevalence of non-melanoma skin cancer (NMSC) (p < 0.0001), erythema nodosum (p < 0.0001), pyoderma gangrenosum (p < 0.0001) and leukocytoclastic vasculitis (p = 0.001).
Besides a prevalence of skin manifestations of 3% related to the inflammatory disease and of 3% related to its treatment, cutaneous disease was a frequent comorbidity in IBD patients, mainly seborrheic diseases. Higher levels of C-reactive protein correlated only with onset of specific lesions of IBD. NMSC prevalence was higher in IBD patients, compared with general population. Psoriasis associated with use of anti-TNF was not found in this research.