Dermatologic disease in Inflammatory Bowel Disease: a 10-year, 401-patient cohort from a dedicated IBD– Dermatology Program

Dermatologic disease is a common and clinically meaningful component of inflammatory bowel disease (IBD) care, particularly in the era of biologic and small-molecule therapies. We performed a 10-year, single-center retrospective cohort study of 401 patients with Crohn’s disease, ulcerative colitis, or indeterminate colitis evaluated at their initial visit in a dedicated IBD–Dermatology clinic to characterize reasons for initial presentation, dermatologic diagnoses, and management patterns. Nearly half presented for full-body skin examination (184/401, 45.9%), most commonly for surveillance while receiving immunosuppressive IBD therapy, and 158/401 (39.4%) presented for nonspecific rash. Dermatologic conditions associated with IBD by epidemiologic prevalence were frequent (123/401, 30.7%) and treatment-related cutaneous adverse events accounted for a substantial proportion of diagnoses (72/401, 18.0%), exceeding both reactive and IBD-specific cutaneous extraintestinal manifestations combined (64/401, 16.0%). Non–IBD-related dermatologic diagnoses occurred in 207/401 (51.6%), reflecting a substantial burden of general dermatologic disease and care needs. Notably, 13 individuals (3.2%) were diagnosed with IBD following dermatologic evaluation, and in nine cases, dermatology-initiated gastroenterology referral despite absent gastrointestinal symptoms. Paradoxical psoriasiform and eczematous eruptions, most often associated with anti–tumor necrosis factor therapy, were the predominant treatment-related presentations. Effective IBD therapy was typically preserved through coordinated dermatologic management: 52/72 (72.2%) continued the existing regimen and 17/72 (23.6%) transitioned to an alternative biologic or JAK inhibitor; more than half of those continuing therapy experienced partial or complete rash resolution. Dermatologic disease in IBD spans reactive and IBD-specific cutaneous extraintestinal manifestations, epidemiologically associated conditions, treatment-related toxicity, and general dermatologic disease and preventive care needs. While some diagnoses likely reflect background skin disease, others may warrant reconsideration as IBD-associated as epidemiologic and treatment-related data evolve. Integrated dermatology–gastroenterology care is essential to preserve IBD control while addressing cutaneous complications, and ongoing study of IBD-associated and treatment-related skin disease is needed as therapies evolve.