Impact of skin examination prior to initiation of treatment with biologics in Inflammatory Bowel Disease patients: preliminary data

Background Mucocutaneous findings are common in patients with Crohn’s disease (CD) and ulcerative colitis (UC). Adverse skin reactions induced by anti-inflammatory treatment schedules for inflammatory bowel disease (IBD) add to the overall increased risk of skin reactions. We aimed to determine if a skin investigation prior to initiation of biologics in IBD patients will detect relevant skin diseases and change further patient management.

Methods This is an ongoing multicenter cohort study performed in 4 tertiary IBD centers and dermatological departments. IBD patients requiring biological treatment underwent a dermatological screening prior to initiation of biologics. All pathological findings, as well as IBD-specific data, were recorded. A descriptive analysis was performed.

Results 502 patients (50 % female) with a median disease duration (IQR) of 6.9 (2, 15) years were eligible for inclusion. 364 patients (72.5 %) had CD, 125 (24.9 %) UC and 13 (2.6 %) inflammatory bowel disease unclassified (IBDU). Median age (IQR) was 37 (29, 49) years. 330 (65.7 %) patients had previously received any kind of immunosuppressive therapy, 168 (33.5 %) patients had a prior biological therapy. Melanoma was diagnosed in 5 patients (1.0 %), 4 cases were staged as T1a, one was a Tis. Non-melanoma skin cancers were detected in 24 patients (4.8 %). IBD associated skin diseases, such as pyoderma gangrenosum, hidradenitis suppurativa and erythema nodosum were present in 5 (1.0 %), 16 (3.2 %) and 3 (0.6 %) patients, respectively. Viral warts were found in 77 patients (15.3 %). All patients received appropriate treatment. Melanoma patients were successfully treated by excision and are currently in remission without requiring adjuvant treatment.

Conclusion A dermatological screening before initiation of biologicals is helpful in identifying patients with skin cancer and other high-impact dermatological diseases and should therefore be part of the pre-treatment screening program.

Publication History

Article published online:
01 September 2021