Mucocutaneous manifestations in patients with inflammatory bowel diseases and association with pathergy positivity and disease severity

Inflammatory bowel disease (IBD) is a chronic disease with relapses and remissions, which are able to attack in different localizations of the gastrointestinal tract (GIT), characterized by local inflammation responsible for intestinal symptoms and systemic inflammation responsible for extraintestinal manifestations (EIM). As a result of systemic inflammation, EIM related to almost any organ system can be seen; joints, skin, eyes and hepatobiliary manifestations are the main involvement. Some of these manifestations are associated with active bowel disease. Approximately one third of IBD patients may have skin manifestations before, during or after the diagnosis. Pathergy test is primarily used for the diagnosis of Behçet's disease (BD), is thought to be related to the activation period of the disease and is a phenomenon of hyperreactivity of the skin against minor traumas. Pathergy test positivity may be expected in IBD patients because of some common clinical findings between BD and IBD. In this study, we aimed to determine the mucocutaneous findings observed in IBD patients in our region and to determine the relationship of these findings with factors such as age, sex, IBD type, severity and pathergy test. Our study was carried out with total of 148 patients who were applied to the Gastroenterology Outpatient Clinic with the diagnosis of 101 ulcerative colitis (UC) and 47 Crohn's disease (CD). All of the mucocutaneous findings and diseases related or non-related to IBD, that found with detailed dermatological examination of the patients, were compared with age, sex, IBD type, disease severity, and pathergy test. In addition, the articular and ocular findings of patients were compared with disease severity and pathergy test. We found only aphthous stomatitis among the reactive mucocutaneous findings associated with IBD and found a statistically significant relationship between the severity of the disease and aphthous stomatitis. (UC; p=0.048, CD; p=0.008). We found only anal fissure and perianal fistula findings from specific mucocutaneous findings and we found higher frequency of CD patients than UC patients.(p=0.033) When the complications that developed secondary to treatment were examined, 5% of CD patients had psoriasis due to anti-TNF use and acne due to corticosteroid use in 4.3% of UC patients. The complications related to the treatment in patients with UC were significantly different in terms of disease severity (p = 0.004). A statistically significant relationship was found between disease severity and pathergy positivity. (P <0.001). Pathergy positivity was statistically higher in male patients than in female patients (p = 0.034). There was a statistically significant relationship between pathergy positivity and uveitis (p = 0.042). A statistically significant relationship was found between the complications occurring secondary to treatment and pathergy test positivity in IBD patients (p = 0.001). There was a statistically significant relationship between the disease severity and folliculitis and acrochordon findings in UC patients. (P = 0.048). Acrochordon was found in 46.2% of the patients with pathergy positivity, and seborrheic keratosis was found in 46.2% of the patients (p = 0.018, p = 0.037). As a result, many mucocutaneous findings related to the disease can be seen in IBD and it should be known that these findings may be related to factors such as disease severity and pathergy test. Our study of mucocutaneous findings in IBD patients that examined the relationship between disease severity and pathergy test, the first in this region and is the second study conducted in Turkey. However, in order to clarify the relationship between mucocutaneous manifestations and the severity of IBD and pathergy positivity, there is a need for studies with larger patient groups that are newly diagnosed and do not have immunosuppressive treatment yet. Key words: Inflammatory bowel diseases, Ulcerative colitis, Crohn's disease, disease severity, mucocutaneous findings, pathergy test