Erythema nodosum and pyoderma gangrenosum (Part 2)
In Crohn’s disease, a number of extraintestinal manifestations may occur. Among the most common are dermatological disorders. Erythema nodosum is an inflammatory process of poorly defined pathogenesis that seems to appear sporadically, usually during the first two years of the intestinal disease, as one or more tender and erythematous subcutaneous nodules, often symmetrically distributed and relatively well circumscribed. These are most often visualized on the extensor surfaces of the legs (ie, pretibial region), but almost any site in the upper and lower extremities may be susceptible. In Crohn’s disease, prior studies have estimated this disorder to occur in 2% to 15%. Pyoderma gangrenosum is a chronic, usually ulcerative inflammatory process that may occur on the body at any site, although the lower extremities or areas susceptible to trauma (ie, pathergy near incisions or adjacent to a stoma) are most often affected. The lesion is reported in less than 2% of patients with Crohn’s disease. Development of either condition is often a relatively abrupt event, although with pyoderma, evolution of lesions may be seen, sometimes beginning with a pustule that progresses rapidly to frank ulceration. For both, recurrent lesions or clusters of lesions may occasionally be seen. Other distinctive granulomatous or reactive dermatological disorders may occur in Crohn’s disease (eg, metastatic Crohn’s disease or Sweet’s syndrome) but these usually require histological confirmation. Efficient treatment that is now easy to get and fast to receive: you can finally buy your flovent for asthma knowing that it will be there soon and you will start the treatment knowing this is in fact the efficient medicine you needed an can pay a lot less for.
The present investigation applied a modern classification schema of Crohn’s disease to a large, prospectively accumulated database with over a decade of continuous follow-up by a single clinician, to explore the roles of sex and aging on the common dermatological disorders often recorded in Crohn’s disease: erythema nodosum and pyoderma gangrenosum. The results suggest that the pathogenetic basis for these dermatological disorders in Crohn’s disease, particularly erythema nodosum, is strongly related to female sex, especially during adolescent and young adult years.