The following are 12 skin conditions that may affect people with ulcerative colitis.
1. Erythema Nodosum
The most common skin condition associated with ulcerative colitis, erythema nodosum is a rash consisting of painful, raised bumps that usually appear on the legs.
“Erythema nodosum is a form of panniculitis, or inflammation of the subcutaneous fat in your skin,” says Susan Massick, MD, a dermatologist at the Ohio State University Wexner Medical Center in Columbus, Ohio. “It can be associated with IBD flares or signal an impending flare.”
You may also run a fever, have joint pain, and generally feel ill.
Treatment usually focuses on treating the underlying IBD. Erythema nodosum can resolve on its own with time, Dr. Massick says. But interventions such as pain-relieving medications, steroids (either taken by mouth or injection), or potassium iodide solution may help alleviate discomfort and clear up the bumps. Massick also recommends elevating your legs and limiting physical activity to help lessen swelling and tenderness.
Symptoms of erythema nodosum usually go away within three to six weeks, but the residual bruises may last for months, and the rash may come back.
2. Pyoderma Gangrenosum
This severe and debilitating condition starts with one or more small pink or purple bumps or pustules that quickly progress to large ulcers, says Madeline DeWane, MD, a dermatologist at Massachusetts General Hospital in Boston. These usually appear on the legs but can occur in other places.
In addition to sores, the disorder can cause fever, joint pain, and general malaise. Unlike many other ulcerative colitis–related skin conditions, pyoderma gangrenosum can appear even when someone’s IBD is well-controlled, Dr. DeWane notes.
Treatments may include medicines that target the skin, such as anti-inflammatory creams, steroid ointments, and steroids injected into the ulcers, as well as therapies with stronger effects, such as steroid pills and immune-suppressing medication.
3. Aphthous Stomatitis
Better known as canker sores, these are small mouth ulcers that usually form along the gum lines, on the inner lip, or along the sides or base of the tongue. They’re usually white in the center with a red rim, Massick says. These usually coincide with disease flare-ups but can also stem from IBD-related nutrient deficiencies, she says.
“Treat the flare, and these canker sores will improve,” she says. “For short-term pain relief, medicated mouthwashes can help soothe. Also, avoid any harsh triggers, like acidic or spicy foods.”
4. Pyoderma Vegetans
This is a rare skin manifestation of ulcerative colitis, Massick says.
“These are rough, warty raised plaques in skin folds, such as in the groin and armpits, often associated with darkening of the skin,” Massick says.
Pyostomatitis vegetans is the same condition, but it occurs in the mouth, DeWane says.
This skin disorder usually runs in a parallel track to the ulcerative colitis flare, DeWane says. Treatment typically involves treating the ulcerative colitis itself. In some cases, a doctor may recommend a topical steroid.
5. Sweet Syndrome
This is another rare skin complication that can be associated with ulcerative colitis. The problem occurs more frequently in women than men and mostly between ages 30 and 50.
“Sweet syndrome typically appears as painful, pink or purple bumps on the head, neck, torso, and arms,” DeWane says. “It may be accompanied by fever, joint pain, or eye inflammation.”
This condition may look like erythema nodosum. Your doctor should be able to tell the difference by performing an exam and running some tests on your skin.
Sweet syndrome usually responds quickly to oral steroids but can also be treated with other anti-inflammatory medications, DeWane says. Once your ulcerative colitis is under control, sweet syndrome is less likely to return.
6. Finger Clubbing
In this condition, the skin underneath your fingernails thickens, and the fingertips become rounded, fat, and purplish, Massick says. The fingernails may also slope downward.
Patients with ulcerative colitis who smoke or have chronic pulmonary disease are at the highest risk for finger clubbing.
The clubbing itself is not harmful, and there is no treatment for it. But it’s still important for your medical team to be aware of any skin and nail changes and to address the underlying ulcerative colitis.
7. Hidradenitis Suppurativa
This is a chronic skin condition causing painful nodules and boils, usually in the skin folds of the armpits and groin area, DeWane says.
“Hidradenitis suppurativa can be debilitating and lead to severe scarring, so early diagnosis and treatment is very important,” she says.
There are multiple treatment options depending on the disease’s severity and what body parts are affected, including topical anti-inflammatory medications, steroid injections, antibiotics, immunosuppressant medications, and surgery, she says.
8. Psoriasis
Because IBD and psoriasis share similar autoimmune pathways, some people develop both conditions, Massick says.
On lighter skin tones, psoriasis manifests as pink patches and silvery scales, usually on the knees, elbows, scalp, and trunk, she says. On darker skin, psoriasis lesions may appear purple or grayish.
9. Vitiligo
Another chronic autoimmune condition, vitiligo involves a loss of pigment in the skin, Massick says.
“It looks like depigmented patches that remain white in color or won’t tan,” she says.
Although not caused directly by ulcerative colitis, vitiligo can occur alongside it since both conditions involve immune dysfunction, says Hannah Kopelman, DO, a dermatologist at Kopelman Aesthetic Surgery with offices in New York City. Some research has also linked it to certain biologic IBD medications.
Usually, vitiligo is only a cosmetic issue and doesn’t require treatment.
But ultraviolet light therapy or immunosuppressant medications may help change the pigment or slow disease progression.
10. Acne
Pimples and other lesions can form when hair follicles become clogged with oil or dead skin cells. Some people with ulcerative colitis struggle with acne due to inflammation, or as a side effect of steroids, Kopelman says.
She usually recommends gentle skin care, noncomedogenic products (which don’t clog pores), and sometimes topical or oral medications to keep breakouts under control.
A rare condition related to intestinal bacterial overgrowth, bowel-associated dermatosis-arthritis syndrome (BADAS) can cause flu-like symptoms followed by red or purple skin lesions and joint pain, Massick says.
“The bacterial overgrowth can be because of the underlying IBD inflammation or because of intestinal surgeries adversely affecting gut function,” she says.
Managing IBD can help alleviate BADAS, but oral antibiotics or other treatments, such as immunosuppressive drugs, are usually also necessary.
12. Hives
Some people with ulcerative colitis develop allergic reactions to IBD medications, which can cause itchy, raised red bumps or hives, says Qin Rao, MD, a physician at Manhattan Gastroenterology in New York City.
If you get hives after starting a new IBD treatment, talk to your doctor about switching medications. They may also recommend antihistamines and topical steroids, Dr. Rao says.
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