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

Dermatologic disease in Inflammatory Bowel Disease: a 10-year, 401-patient cohort from a dedicated IBD– Dermatology Program | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Dermatologic disease in Inflammatory Bowel Disease: a 10-year, 401-patient cohort from a dedicated IBD– Dermatology Program Dorsa Moslehi, Rahul S. Dalal, Punyanganie de Silva, Alexandra P. Charrow This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8628611/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract 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. Inflammatory bowel disease Cutaneous extraintestinal manifestations Paradoxical cutaneous reactions Crohn’s disease Ulcerative colitis Introduction Skin disease is common in Inflammatory Bowel Disease (IBD) and contributes substantially to morbidity [ 1 – 4 ]. Traditionally, dermatologic conditions seen in patients with IBD have been categorized as reactive, specific, or associated [ 5 ]. Reactive lesions (e.g., erythema nodosum (EN), pyoderma gangrenosum (PG), Sweet’s syndrome (SS), cutaneous vasculitis) are immunologically mediated and related to underlying IBD; specific lesions (e.g., cutaneous Crohn’s disease and oral manifestations) share histopathologic features with intestinal disease; and associated conditions (e.g., hidradenitis suppurativa and psoriasis) occur with increased prevalence in IBD. With expanding use of biologic and small-molecule therapies, treatment-related dermatologic complications have become an increasingly important and distinct consideration in contemporary IBD care. Contemporary real-world data describing the spectrum of dermatologic presentations in IBD remain limited, and access to specialized dermatologic care is uncommon. While clinical teaching emphasizes classic reactive and specific cutaneous extraintestinal manifestations (EIMs), dermatology referrals in practice often reflect a broader range of disease, including treatment-related eruptions and comorbid skin conditions. The objective of this single-center observational study was to characterize reasons for initial presentation, dermatologic diagnoses, and management patterns among patients evaluated in a dedicated IBD–Dermatology program over a 10-year period. Methods We conducted a single-center retrospective chart review of patients with IBD evaluated in the Crohn’s and Ulcerative Colitis Dermatology Program at Brigham and Women’s Hospital (BWH), Boston, Massachusetts. Patients were identified using the Mass General Brigham Research Patient Data Registry (RPDR). Eligible patients had ≥ 1 documented encounter with the specialty provider and an ICD-9/10 code or clinical phenotype consistent with Crohn’s disease (CD), ulcerative colitis (UC), or indeterminate colitis (IC). Variables were manually abstracted and entered into REDCap. For individuals with established IBD, IBD-related data were collected at the time of the first dermatology visit; for those diagnosed after the first dermatology visit, data were abstracted from the earliest record confirming IBD. Analyses were limited to initial dermatology visits and diagnoses made at that visit or confirmed on biopsy obtained during the visit. Treatment outcomes were assessed from the initial note and up to five follow-up visits. Institutional Review Board approval was obtained (Protocol 2015P000838) with waiver of consent. Results I. Patient Demographics, Dermatologic History, and IBD Disease Characteristics The initial search identified 710 patients; 401 patients met inclusion criteria, aged 15–87 (mean age of 40 ± 2.1 years, median age of 36 years, 62.1% female) (Table 1 ). CD (n = 263, 65.6%) was more commonly represented than UC (n = 116, 28.9%). At initial presentation, 96.8% of patients had established IBD, with a mean disease duration of 15.3 years. Most patients had remission or mild disease by Harvey–Bradshaw Index (< 8; 206/245 [84.1%]) and Mayo score (≤ 6; 99/115 [86.1%]). Non-cutaneous EIMs were present in 31.1% of patients, most commonly musculoskeletal, followed by ocular and hepatobiliary involvement. Lifetime IBD treatment exposure included biologics (329/401 [82.0%]), corticosteroids (319/401 [79.6%]), aminosalicylates (289/401 [72.1%]), non-steroid immunomodulators (227/401 [56.6%]), surgery (129/401 [32.2%]), and Janus kinase (JAK) inhibitors (19/401 [4.7%]). Seven patients (1.7%) received no IBD-related therapy. Overall, 233 patients (58.1%) had a prior dermatologic diagnosis, most commonly acne, aphthous ulcers, eczema, and psoriasis. II. Indication for Initial Dermatologic Evaluation Among 401 patients, 184 (45.9%) presented for a full-body skin examination (FBSE) and 158 (39.4%) presented for rashes not otherwise specified. Most FBSE visits were for routine surveillance in the setting of immunosuppressive IBD therapy (174/184, 94.6%). III. Types of Dermatologic Diagnoses Initial visit diagnoses are outlined in Table 1 . Among IBD-related dermatologic conditions, dermatologic conditions associated with IBD by epidemiologic prevalence accounted for 30.7% (123/401) of diagnoses. Treatment-related dermatologic conditions, including paradoxical psoriasis or eczema, bacterial skin infections, and drug-induced acne, accounted for 18.0% (72/401) of diagnoses. IBD-specific dermatologic lesions accounted for 12.7% (51/401) of diagnoses. Reactive lesions, including EN and PG, accounted for 3.2% (13/401). Non-IBD-related dermatologic conditions including fungal skin infections, acne/rosacea, viral warts, non-melanoma skin cancer (NMSC), seborrheic dermatitis, and alopecia, occurred in 207/401 (51.6%). Most NMSC occurred in those with prior thiopurine exposure (7/10, 70.0%). Thirteen patients (3.2%) were diagnosed with IBD only after their dermatology visit. At the initial dermatologic evaluation, these patients presented with cutaneous CD (n = 4), HS (n = 3), PG (n = 1) before a later CD diagnosis; with eczema (n = 1) or non–IBD-related lesions (n = 3) before a later UC diagnosis; or with HS before a later IC diagnosis. Among those with cutaneous CD, involvement was predominantly vulvar or perineal, with presentations including diffuse edema, fissures, cobblestoning, and characteristic knife-like ulcerations. IV. IBD Treatment–Associated Dermatologic Lesions IBD treatment–associated dermatologic lesions, in order of prevalence, were secondary to biologics, corticosteroids, and JAK inhibitors. Among biologic-associated reactions, anti–tumor necrosis factor (TNF) agents were most common, with additional cases among interleukin (IL)–12/23 and IL-23 inhibitors. Treatment-associated diagnoses included paradoxical psoriasis or eczema (37/72, 51.4%), bacterial skin infections (27/72, 37.5%), and drug-induced acne (8/72, 11.1%). Management strategies included continuation of IBD therapy, switch to an alternative agent, or discontinuation of treatment entirely (Table 2 ). Discussion In this 10-year retrospective study of 401 patients evaluated in a dedicated IBD–Dermatology program, we found that cutaneous disease in IBD is clinically meaningful and frequently intersects with IBD-associated therapeutic decision-making. Traditional cutaneous EIMs, including reactive lesions and IBD-specific manifestations, were uncommon at initial presentation (3.2% of diagnoses), while IBD-specific cutaneous manifestations accounted for 12.7%. By comparison, treatment-related cutaneous disease represented a substantial proportion of IBD-related diagnoses (18.0%), reflecting the growing impact of biologic and small-molecule therapies on the dermatologic landscape of contemporary IBD care. Paradoxical rashes, particularly psoriasiform and eczematous eruptions, were the most frequent treatment-associated presentations and were most often linked to TNF inhibitors [6, 7]. Most patients were in IBD remission at rash onset and remained on an effective regimen, either through continuation of the existing regimen (52/72, 72.2%) or transition to an alternative biologic or JAK inhibitor (17/72, 23.6%). More than half of patients who continued therapy experienced partial or complete rash resolution, supporting a management strategy in which treatment discontinuation is reserved for severe or refractory cutaneous toxicity[3, 8]. Dermatology also played an important diagnostic role. Thirteen patients were diagnosed with IBD following dermatologic evaluation, having presented with HS, cutaneous CD, or PG. In nine cases, dermatology initiated GI referral despite absent GI symptoms. The mean interval from dermatologic presentation to IBD diagnosis was 1.8 years, underscoring that cutaneous findings may precede intestinal disease. Beyond IBD-related manifestations, over half the cohort had dermatologic diagnoses not traditionally classified as IBD-related but increasingly reported in IBD patients, including acne/rosacea, alopecia, seborrheic dermatitis, and viral warts [4, 9-10].NMSC was also observed, usually in the setting of prior thiopurine exposure, consistent with treatment-associated risk rather than IBD-related pathogenesis. Strengths of this study include its large cohort, decade-long capture period, and structured multidisciplinary clinic setting. Limitations include the single-center retrospective design and referral bias toward complex cases. Conclusion Dermatologic disease in IBD spans reactive and IBD-specific cutaneous EIMs, 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. Statements and Declarations Sources of support that require acknowledgment : None Authors’ financial disclosures and conflicts of interest : None Data availability statement : The data underlying this article cannot be shared publicly due to privacy and ethical restrictions. De-identified patient-level data are available from the Mass General Brigham Research Patient Data Registry upon reasonable request and with appropriate institutional approvals. Acknowledgements and Conflicts of Interest Acknowledgements: Author Contributions: A.C. designed the study. A.C. and D.M. contributed to data analysis. A.C. and D.M. drafted tables. A.C. and D.M. drafted the manuscript. All authors read, edited, and approved the submitted manuscript. Funders: None. Conflicts of Interest: None. Prior Presentations: None. References Kilic Y, Kamal S, Jaffar F, et al. Prevalence of Extraintestinal Manifestations in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Inflamm Bowel Dis 2024; 30: 230–239. Kayar Y, Dertli R, Konür Ş, et al. Mucocutaneous Manifestations and Associated Factors in Patients with Crohn’s Disease. Turk J Gastroenterol Off J Turk Soc Gastroenterol 2022; 33: 945–954. Levy N, Matz H, Maharshak N, et al. P609 An IBD dermatology multidisciplinary clinic: A single tertiary centre experience. J Crohns Colitis 2020; 14: S508–S509. Tsilimpotis D, Kyriakou G, Biedermann L, et al. Cutaneous Manifestations and Dermatologic Adverse Events in IBD: A Clinical Update. Inflamm Bowel Dis 2025; izaf228. Greuter T, Navarini A, Vavricka SR. Skin Manifestations of Inflammatory Bowel Disease. Clin Rev Allergy Immunol 2017; 53: 413–427. Gordon H, Burisch J, Ellul P, et al. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis 2024; 18: 1–37. Nigam GB, Bhandare AP, Antoniou GA, et al. Systematic review and meta-analysis of dermatological reactions in patients with inflammatory bowel disease treated with anti-tumour necrosis factor therapy. Eur J Gastroenterol Hepatol 2021; 33: 346–357. Yanai H, Amir Barak H, Ollech JE, et al. Clinical approach to skin eruptions induced by anti-TNF agents among patients with inflammatory bowel diseases: insights from a multidisciplinary IBD-DERMA clinic. Ther Adv Gastroenterol 2021; 14: 17562848211053112. Jun YK, Yu D-A, Han YM, et al. The Relationship Between Rosacea and Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Dermatol Ther 2023; 13: 1465–1475. Narous M, Nugent Z, Singh H, et al. Risks of Melanoma and Nonmelanoma Skin Cancers Pre– and Post–Inflammatory Bowel Disease Diagnosis. Inflamm Bowel Dis 2023; 29: 1047–1056. Tables Table 1. Baseline Demographic and Clinical Characteristics, Dermatologic Presentation Patterns, and Initial Visit Diagnoses in Patients with Inflammatory Bowel Disease (n=401). Baseline Demographic and Clinical Characteristics Overall Prevalence (n=401) Crohn’s Disease (n=263) Ulcerative Colitis (n=116) Indeterminate Colitis (n=22) Average age ± SD 40 ± 2.1 38 42 45 Sex, N (%) Male 153 (38.2) 101 (38.4) 41 (35.3) 10 (45.5) Female 249 (62.1) 162 (61.6) 75 (64.7) 12 (54.5) Race/Ethnicity, N (%) White 350 (87.3) 231 (87.8) 97 (83.6) 21 (95.5) Black 21 (5.2) 15 (5.7) 6 (5.2) 0 Hispanic/Latino 17 (4.2) 11 (4.2) 6 (5.2) 0 Asian 9 (2.2) 4 (1.5) 4 (3.4) 1 (4.5) None indicated 5 (1.2) 2 (0.76) 3 (2.6) 0 Smoking status, N (%) Current 18 (4.4) 15 (5.7) 3 (2.6) 0 Former 76 (19.0) 44 (16.7) 25 (21.6) 6 (27.3) Never 306 (76.3) 203 (77.2) 87 (0.75) 16 (72.7) Unknown 2 (0.50) 1 (0.38) 1 (0.86) 0 Average body mass index (range), kg/m 2 26 (16-63) 26 (16-63) 26 (17-48) 27 (16-45) Existing IBD diagnosis at time of first dermatology visit, N (%) 388 (96.8) 255 (97.0) 112 (96.6) 21 (95.5) Average time since IBD diagnosis ± SD, years 15.34 ± 14.44 15.77 ± 14.59 13.48 ± 11.22 15.14 ± 9.94 Future IBD diagnosis, N (%) 13 (3.2) 8 (3.0) 4 (3.4) 1 (4.5) Average time to IBD diagnosis ± SD, years 1.78 ± 1.68 years 0.625 ± 1.32 years 2.75 ± 1.30 years 1.50 years Reason for Initial Presentation to Dermatology Clinic, N (%) Overall Prevalence (n=401) Crohn’s Disease (n=263) Ulcerative Colitis (n=116) Indeterminate Colitis (n=22) Specific cutaneous manifestation of IBD + Examples include aphthous stomatitis, oral ulcer, perianal or peristomal ulcer, perianal fissure, perianal fistula, cutaneous Crohn’s disease 16 (4.0) 14 (5.3) 0 (0.0) 2 (9.1) Reactive cutaneous manifestation of IBD + Examples include erythema nodosum, pyoderma gangrenosum, sweet's syndrome, bowel-associated dermatosis-arthritis syndrome, leukocytoclastic vasculitis, pyodermatitis/pyostomatitis vegetans 5 (1.2) 3 (1.1) 1 (0.86) 1 (4.6) Cutaneous manifestation associated with IBD + Examples include hidradenitis suppurativa, psoriasis, atopic dermatitis, vitiligo, acquired epidermolysis bullosa, secondary amyloidosis 71 (17.7) 51(19.4) 15 (12.9) 5 (22.7) Cutaneous manifestation due to adverse effect of IBD treatment Examples include corticosteroid or Janus Kinase inhibitor induced acne, paradoxical psoriasiform or eczematous dermatitis 14 (3.5) 10 (3.8) 4 (3.5) 0 (0.0) Peristomal rash not otherwise specified 12 (3.0) 10 (3.8) 2 (1.7) 0 (0.0) Rash or lesion not otherwise specified 158 (39.4) 107 (40.7) 39 (33.6) 12 (54.6) Full body skin exam in the setting of immunosuppressive IBD therapy 174 (43.4) 112 (42.6) 57 (49.1) 5 (22.7) Full body skin exam not in the setting of immunosuppressive IBD therapy 10 (2.5) 5 (1.9) 5 (4.3) 0 (0.0) Dermatologic condition traditionally considered unrelated to IBD Includes acne vulgaris, rosacea, nonmelanoma skin cancer, alopecia (areata, androgenic, telogen effluvium), seborrheic dermatitis, viral warts, fungal infection, lichenoid dermatosis, contact dermatitis 92 (22.9) 55 (20.9) 32 (27.6) 5 (22.7) Diagnosis Made at Initial Dermatology Visit, N (%) Overall Prevalence (n=401) Crohn’s Disease (n=263) Ulcerative Colitis (n=116) Indeterminate Colitis (n=22) Specific cutaneous manifestation of IBD + 51 (12.7) 43 (16.4) 5 (4.3) 3 (13.6) Reactive cutaneous manifestation of IBD + 13 (3.2) 9 (3.4) 3 (2.6) 1 (4.5) Cutaneous manifestation associated with IBD + 123 (30.7) 89 (33.8) 27 (23.3) 7 (31.8) Cutaneous manifestation due to adverse effect of IBD treatment 72 (18.0) 54 (20.5) 16 (13.8) 2 (9.1) Rash or lesion not otherwise specified 3 (0.75) 2 (0.76) 1 (0.86) 0 (0.0) Dermatologic condition traditionally considered unrelated to IBD 207 (51.6) 131 (49.8) 63 (54.3) 13 (59.1) No diagnosis made * 53 (13.2) 30 (11.4) 22 (18.9) 1 (4.5) * Benign variant skin findings (e.g., melanocytic nevi, seborrheic keratoses, keratosis pilaris) were not counted as diagnoses unless bothersome to the patient or requiring treatment. + Reactive lesions include immunologically mediated cutaneous manifestations related to underlying IBD; specific share histopathologic features with intestinal disease; and associated conditions with increased prevalence in patients with IBD. Note: “Average time since IBD diagnosis ± SD, years” refers to patients with an established IBD diagnosis at their first dermatology visit. “Average time to IBD diagnosis ± SD, years” refers to patients who received a new IBD diagnosis after their initial dermatology visit. Abbreviations: IBD, inflammatory bowel disease; SD, standard deviation Table 2. Summary of Management Strategies and Dermatologic Outcomes Among Patients with IBD Treatment-Associated Cutaneous Disease (n = 72). Total, N Paradoxical psoriasis or eczema (N=37) Bacterial skin infection (N=27) Drug-induced acne (N=8) Continued therapy 52 21 23 8 Complete resolution 14 3 6 1 Partial resolution 14 8 4 2 Stable 8 3 3 2 Progressive 3 1 1 0 Unknown 18 6 9 3 Switched therapy 17 15 2 0 Complete resolution 6 6 0 0 Partial resolution 10 8 2 0 Stable 1 0 0 0 Progressive 0 1 0 0 Discontinued therapy 3 1 2 0 Complete resolution 1 0 1 0 Partial resolution 0 1 1 0 Stable 2 0 0 0 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 16 Feb, 2026 Reviewers invited by journal 10 Feb, 2026 Editor assigned by journal 19 Jan, 2026 Submission checks completed at journal 19 Jan, 2026 First submitted to journal 17 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8628611","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":591736279,"identity":"50390454-1093-4766-8a4d-21ad29bbe64b","order_by":0,"name":"Dorsa Moslehi","email":"","orcid":"","institution":"Harvard Medical School","correspondingAuthor":false,"prefix":"","firstName":"Dorsa","middleName":"","lastName":"Moslehi","suffix":""},{"id":591736280,"identity":"40e6c458-21c2-45f4-ad24-ee5f79c047c9","order_by":1,"name":"Rahul S. Dalal","email":"","orcid":"","institution":"Brigham and Women's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Rahul","middleName":"S.","lastName":"Dalal","suffix":""},{"id":591736281,"identity":"67ba9c9b-9a0b-4e79-8fdb-abd658569733","order_by":2,"name":"Punyanganie de Silva","email":"","orcid":"","institution":"Harvard Medical School","correspondingAuthor":false,"prefix":"","firstName":"Punyanganie","middleName":"","lastName":"de Silva","suffix":""},{"id":591736282,"identity":"a8543568-5f57-4ab4-a431-8ac4b9814283","order_by":3,"name":"Alexandra P. Charrow","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDElEQVRIie3RsUoDMQDG8cuiy5VbcxzYF+iQcpAuBV/FIGTK0UFwEu6mTFdc4+QrHBTqAwSuS3TOZkXQxcEupcVQTXSSkh44OeQ/ZfnxJSSKQqF/2NGxQnJrxuS6X2MIOCyRTF6XwBhSeUgSs+Fzj1NyI5QjY9IsaoxA1XpJKgZ53uOSNJo5QkmjnK2klyAd48yRmf5ekXaOdZFknW2NLOaP07sN2MkyFZMXCDYdK0/vluj7uVu5soQfXDnV8ehjKGQxE4UjnzTpv7UdFxvgLK1l2cDJ2q2cJ5DRw0Qx93x6IfTDJST2+RwyjEjV5h4RoYVyxH7lrf3K1Q8ZLVfGnPjI7872DqFQKBT6U1+Wg3w28L4DuwAAAABJRU5ErkJggg==","orcid":"","institution":"Harvard Medical School","correspondingAuthor":true,"prefix":"","firstName":"Alexandra","middleName":"P.","lastName":"Charrow","suffix":""}],"badges":[],"createdAt":"2026-01-18 00:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8628611/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8628611/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102738159,"identity":"d33f0c8a-760d-46d7-9b49-c4dc01ef69c4","added_by":"auto","created_at":"2026-02-16 06:56:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1417038,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8628611/v1/19e52e3c-c6b0-4ce3-8a10-fbf03f07703d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Dermatologic disease in Inflammatory Bowel Disease: a 10-year, 401-patient cohort from a dedicated IBD– Dermatology Program","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSkin disease is common in Inflammatory Bowel Disease (IBD) and contributes substantially to morbidity [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Traditionally, dermatologic conditions seen in patients with IBD have been categorized as reactive, specific, or associated [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Reactive lesions (e.g., erythema nodosum (EN), pyoderma gangrenosum (PG), Sweet\u0026rsquo;s syndrome (SS), cutaneous vasculitis) are immunologically mediated and related to underlying IBD; specific lesions (e.g., cutaneous Crohn\u0026rsquo;s disease and oral manifestations) share histopathologic features with intestinal disease; and associated conditions (e.g., hidradenitis suppurativa and psoriasis) occur with increased prevalence in IBD. With expanding use of biologic and small-molecule therapies, treatment-related dermatologic complications have become an increasingly important and distinct consideration in contemporary IBD care.\u003c/p\u003e \u003cp\u003eContemporary real-world data describing the spectrum of dermatologic presentations in IBD remain limited, and access to specialized dermatologic care is uncommon. While clinical teaching emphasizes classic reactive and specific cutaneous extraintestinal manifestations (EIMs), dermatology referrals in practice often reflect a broader range of disease, including treatment-related eruptions and comorbid skin conditions. The objective of this single-center observational study was to characterize reasons for initial presentation, dermatologic diagnoses, and management patterns among patients evaluated in a dedicated IBD\u0026ndash;Dermatology program over a 10-year period.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e We conducted a single-center retrospective chart review of patients with IBD evaluated in the Crohn\u0026rsquo;s and Ulcerative Colitis Dermatology Program at Brigham and Women\u0026rsquo;s Hospital (BWH), Boston, Massachusetts. Patients were identified using the Mass General Brigham Research Patient Data Registry (RPDR).\u003c/p\u003e \u003cp\u003eEligible patients had\u0026thinsp;\u0026ge;\u0026thinsp;1 documented encounter with the specialty provider and an ICD-9/10 code or clinical phenotype consistent with Crohn\u0026rsquo;s disease (CD), ulcerative colitis (UC), or indeterminate colitis (IC). Variables were manually abstracted and entered into REDCap. For individuals with established IBD, IBD-related data were collected at the time of the first dermatology visit; for those diagnosed after the first dermatology visit, data were abstracted from the earliest record confirming IBD. Analyses were limited to initial dermatology visits and diagnoses made at that visit or confirmed on biopsy obtained during the visit. Treatment outcomes were assessed from the initial note and up to five follow-up visits.\u003c/p\u003e \u003cp\u003e Institutional Review Board approval was obtained (Protocol 2015P000838) with waiver of consent.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eI. Patient Demographics, Dermatologic History, and IBD Disease Characteristics\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe initial search identified 710 patients; 401 patients met inclusion criteria, aged 15\u0026ndash;87 (mean age of 40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 years, median age of 36 years, 62.1% female) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). CD (n\u0026thinsp;=\u0026thinsp;263, 65.6%) was more commonly represented than UC (n\u0026thinsp;=\u0026thinsp;116, 28.9%).\u003c/p\u003e \u003cp\u003eAt initial presentation, 96.8% of patients had established IBD, with a mean disease duration of 15.3 years. Most patients had remission or mild disease by Harvey\u0026ndash;Bradshaw Index (\u0026lt;\u0026thinsp;8; 206/245 [84.1%]) and Mayo score (\u0026le;\u0026thinsp;6; 99/115 [86.1%]). Non-cutaneous EIMs were present in 31.1% of patients, most commonly musculoskeletal, followed by ocular and hepatobiliary involvement.\u003c/p\u003e \u003cp\u003eLifetime IBD treatment exposure included biologics (329/401 [82.0%]), corticosteroids (319/401 [79.6%]), aminosalicylates (289/401 [72.1%]), non-steroid immunomodulators (227/401 [56.6%]), surgery (129/401 [32.2%]), and Janus kinase (JAK) inhibitors (19/401 [4.7%]). Seven patients (1.7%) received no IBD-related therapy. Overall, 233 patients (58.1%) had a prior dermatologic diagnosis, most commonly acne, aphthous ulcers, eczema, and psoriasis.\u003c/p\u003e \u003cp\u003e \u003cb\u003eII. Indication for Initial Dermatologic Evaluation\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAmong 401 patients, 184 (45.9%) presented for a full-body skin examination (FBSE) and 158 (39.4%) presented for rashes not otherwise specified. Most FBSE visits were for routine surveillance in the setting of immunosuppressive IBD therapy (174/184, 94.6%).\u003c/p\u003e \u003cp\u003e \u003cb\u003eIII. Types of Dermatologic Diagnoses\u003c/b\u003e \u003c/p\u003e \u003cp\u003eInitial visit diagnoses are outlined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Among IBD-related dermatologic conditions, dermatologic conditions associated with IBD by epidemiologic prevalence accounted for 30.7% (123/401) of diagnoses. Treatment-related dermatologic conditions, including paradoxical psoriasis or eczema, bacterial skin infections, and drug-induced acne, accounted for 18.0% (72/401) of diagnoses. IBD-specific dermatologic lesions accounted for 12.7% (51/401) of diagnoses. Reactive lesions, including EN and PG, accounted for 3.2% (13/401).\u003c/p\u003e \u003cp\u003eNon-IBD-related dermatologic conditions including fungal skin infections, acne/rosacea, viral warts, non-melanoma skin cancer (NMSC), seborrheic dermatitis, and alopecia, occurred in 207/401 (51.6%). Most NMSC occurred in those with prior thiopurine exposure (7/10, 70.0%).\u003c/p\u003e \u003cp\u003eThirteen patients (3.2%) were diagnosed with IBD only after their dermatology visit. At the initial dermatologic evaluation, these patients presented with cutaneous CD (n\u0026thinsp;=\u0026thinsp;4), HS (n\u0026thinsp;=\u0026thinsp;3), PG (n\u0026thinsp;=\u0026thinsp;1) before a later CD diagnosis; with eczema (n\u0026thinsp;=\u0026thinsp;1) or non\u0026ndash;IBD-related lesions (n\u0026thinsp;=\u0026thinsp;3) before a later UC diagnosis; or with HS before a later IC diagnosis. Among those with cutaneous CD, involvement was predominantly vulvar or perineal, with presentations including diffuse edema, fissures, cobblestoning, and characteristic knife-like ulcerations.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIV. IBD Treatment\u0026ndash;Associated Dermatologic Lesions\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIBD treatment\u0026ndash;associated dermatologic lesions, in order of prevalence, were secondary to biologics, corticosteroids, and JAK inhibitors. Among biologic-associated reactions, anti\u0026ndash;tumor necrosis factor (TNF) agents were most common, with additional cases among interleukin (IL)\u0026ndash;12/23 and IL-23 inhibitors. Treatment-associated diagnoses included paradoxical psoriasis or eczema (37/72, 51.4%), bacterial skin infections (27/72, 37.5%), and drug-induced acne (8/72, 11.1%). Management strategies included continuation of IBD therapy, switch to an alternative agent, or discontinuation of treatment entirely (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this 10-year retrospective study of 401 patients evaluated in a dedicated IBD–Dermatology program, we found that cutaneous disease in IBD is clinically meaningful and frequently intersects with IBD-associated therapeutic decision-making. Traditional cutaneous EIMs, including reactive lesions and IBD-specific manifestations, were uncommon at initial presentation (3.2% of diagnoses), while IBD-specific cutaneous manifestations accounted for 12.7%. By comparison, treatment-related cutaneous disease represented a substantial proportion of IBD-related diagnoses (18.0%), reflecting the growing impact of biologic and small-molecule therapies on the dermatologic landscape of contemporary IBD care.\u003c/p\u003e\n\u003cp\u003eParadoxical rashes, particularly psoriasiform and eczematous eruptions, were the most frequent treatment-associated presentations and were most often linked to TNF inhibitors [6, 7]. Most patients were in IBD remission at rash onset and remained on an effective regimen, either through continuation of the existing regimen (52/72, 72.2%) or transition to an alternative biologic or JAK inhibitor (17/72, 23.6%). \u0026nbsp;More than half of patients who continued therapy experienced partial or complete rash resolution, supporting a management strategy in which treatment discontinuation is reserved for severe or refractory cutaneous toxicity[3, 8].\u003c/p\u003e\n\u003cp\u003eDermatology also played an important diagnostic role. Thirteen patients were diagnosed with IBD following dermatologic evaluation, having presented with HS, cutaneous CD, or PG. In nine cases, dermatology initiated GI referral despite absent GI symptoms. The mean interval from dermatologic presentation to IBD diagnosis was 1.8 years, underscoring that cutaneous findings may precede intestinal disease.\u003c/p\u003e\n\u003cp\u003eBeyond IBD-related manifestations, over half the cohort had dermatologic diagnoses not traditionally classified as IBD-related but increasingly reported in IBD patients, including acne/rosacea, alopecia, seborrheic dermatitis, and viral warts [4, 9-10].NMSC was also observed, usually in the setting of prior thiopurine exposure, consistent with treatment-associated risk rather than IBD-related pathogenesis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStrengths of this study include its large cohort, decade-long capture period, and structured multidisciplinary clinic setting. Limitations include the single-center retrospective design and referral bias toward complex cases.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDermatologic disease in IBD spans reactive and IBD-specific cutaneous EIMs, 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\u0026ndash;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.\u003c/p\u003e"},{"header":"Statements and Declarations","content":"\u003cp\u003e\u003cstrong\u003eSources of support that require acknowledgment\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; financial disclosures and conflicts of interest\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e: The data underlying this article cannot be shared publicly due to privacy and ethical restrictions. De-identified patient-level data are available from the Mass General Brigham Research Patient Data Registry upon reasonable request and with appropriate institutional approvals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements and Conflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e A.C. designed the study. A.C. and D.M. contributed to data analysis. A.C. and D.M. drafted tables. A.C. and D.M. drafted the manuscript. All authors read, edited, and approved the submitted manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunders:\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u0026nbsp;\u003c/strong\u003eNone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrior Presentations:\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eKilic Y, Kamal S, Jaffar F, et al. Prevalence of Extraintestinal Manifestations in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. \u003cem\u003eInflamm Bowel Dis\u003c/em\u003e 2024; 30: 230\u0026ndash;239.\u003c/li\u003e\n \u003cli\u003eKayar Y, Dertli R, Kon\u0026uuml;r Ş, et al. Mucocutaneous Manifestations and Associated Factors in Patients with Crohn\u0026rsquo;s Disease. \u003cem\u003eTurk J Gastroenterol Off J Turk Soc Gastroenterol\u003c/em\u003e 2022; 33: 945\u0026ndash;954.\u003c/li\u003e\n \u003cli\u003eLevy N, Matz H, Maharshak N, et al. P609 An IBD dermatology multidisciplinary clinic: A single tertiary centre experience. \u003cem\u003eJ Crohns Colitis\u003c/em\u003e 2020; 14: S508\u0026ndash;S509.\u003c/li\u003e\n \u003cli\u003eTsilimpotis D, Kyriakou G, Biedermann L, et al. Cutaneous Manifestations and Dermatologic Adverse Events in IBD: A Clinical Update. \u003cem\u003eInflamm Bowel Dis\u003c/em\u003e 2025; izaf228.\u003c/li\u003e\n \u003cli\u003eGreuter T, Navarini A, Vavricka SR. Skin Manifestations of Inflammatory Bowel Disease. \u003cem\u003eClin Rev Allergy Immunol\u003c/em\u003e 2017; 53: 413\u0026ndash;427.\u003c/li\u003e\n \u003cli\u003eGordon H, Burisch J, Ellul P, et al. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. \u003cem\u003eJ Crohns Colitis\u003c/em\u003e 2024; 18: 1\u0026ndash;37.\u003c/li\u003e\n \u003cli\u003eNigam GB, Bhandare AP, Antoniou GA, et al. Systematic review and meta-analysis of dermatological reactions in patients with inflammatory bowel disease treated with anti-tumour necrosis factor therapy. \u003cem\u003eEur J Gastroenterol Hepatol\u003c/em\u003e 2021; 33: 346\u0026ndash;357.\u003c/li\u003e\n \u003cli\u003eYanai H, Amir Barak H, Ollech JE, et al. Clinical approach to skin eruptions induced by anti-TNF agents among patients with inflammatory bowel diseases: insights from a multidisciplinary IBD-DERMA clinic. \u003cem\u003eTher Adv Gastroenterol\u003c/em\u003e 2021; 14: 17562848211053112.\u003c/li\u003e\n \u003cli\u003eJun YK, Yu D-A, Han YM, et al. The Relationship Between Rosacea and Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. \u003cem\u003eDermatol Ther\u003c/em\u003e 2023; 13: 1465\u0026ndash;1475.\u003c/li\u003e\n \u003cli\u003eNarous M, Nugent Z, Singh H, et al. Risks of Melanoma and Nonmelanoma Skin Cancers Pre\u0026ndash; and Post\u0026ndash;Inflammatory Bowel Disease Diagnosis. \u003cem\u003eInflamm Bowel Dis\u003c/em\u003e 2023; 29: 1047\u0026ndash;1056.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eBaseline Demographic and Clinical Characteristics, Dermatologic Presentation Patterns, and Initial Visit Diagnoses in Patients with Inflammatory Bowel Disease (n=401).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"672\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline Demographic and Clinical Characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall Prevalence (n=401)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrohn\u0026rsquo;s Disease\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=263)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUlcerative Colitis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=116)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndeterminate Colitis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=22)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage age \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e40 \u0026plusmn; 2.1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex, N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e153 (38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e101 (38.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e41 (35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e10 (45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e249 (62.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e162 (61.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e75 (64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e12 (54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace/Ethnicity, N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e350 (87.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e231 (87.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e97 (83.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e21 (95.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e21 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e15 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e6 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003eHispanic/Latino\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e17 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e11 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e6 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003eAsian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e9 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e4 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e4 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e1 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003eNone indicated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e5 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e2 (0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e3 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking status, N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003eCurrent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e18 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e15 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e3 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003eFormer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e76 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e44 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e25 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e6 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e306 (76.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e203 (77.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e87 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e16 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e2 (0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e1 (0.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e1 (0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage body mass index (range), kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e26 (16-63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e26 (16-63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e26 (17-48)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e27 (16-45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExisting IBD diagnosis at time of first dermatology visit, N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e388 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e255 (97.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e112 (96.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e21 (95.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage time since IBD diagnosis \u0026plusmn; SD, years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e15.34 \u0026plusmn; 14.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e15.77 \u0026plusmn; 14.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e13.48 \u0026plusmn; 11.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e15.14 \u0026plusmn; 9.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFuture IBD diagnosis, N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e13 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e8 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e4 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e1 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage time to IBD diagnosis \u0026plusmn; SD, years\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e1.78 \u0026plusmn; 1.68 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e0.625 \u0026plusmn; 1.32 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e\u0026nbsp;2.75 \u0026plusmn; 1.30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e1.50 years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReason for Initial Presentation to Dermatology Clinic, N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall Prevalence (n=401)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrohn\u0026rsquo;s Disease\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=263)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUlcerative Colitis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=116)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndeterminate Colitis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=22)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecific cutaneous manifestation of IBD\u003c/strong\u003e+\u003c/p\u003e\n \u003cp\u003eExamples include aphthous stomatitis, oral ulcer, perianal or peristomal ulcer, perianal fissure, perianal fistula, cutaneous Crohn\u0026rsquo;s disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e16 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e14 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e2 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReactive cutaneous manifestation of IBD\u003c/strong\u003e+\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eExamples include erythema nodosum, pyoderma gangrenosum, sweet\u0026apos;s syndrome, bowel-associated dermatosis-arthritis syndrome, leukocytoclastic vasculitis, pyodermatitis/pyostomatitis vegetans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e5 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e3 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e1 (0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e1 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCutaneous manifestation associated with IBD\u003c/strong\u003e+\u003c/p\u003e\n \u003cp\u003eExamples include hidradenitis suppurativa, psoriasis, atopic dermatitis, vitiligo, acquired epidermolysis bullosa, secondary amyloidosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e71 (17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e51(19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e15 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e5 (22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCutaneous manifestation due to adverse effect of IBD treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eExamples include corticosteroid or Janus Kinase inhibitor induced acne, paradoxical psoriasiform or eczematous dermatitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e14 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e10 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e4 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeristomal rash not otherwise specified\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e12 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e10 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e2 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRash or lesion not otherwise specified\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e158 (39.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e107 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e39 (33.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e12 (54.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull body skin exam in the setting of immunosuppressive IBD therapy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e174 (43.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e112 (42.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e57 (49.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e5 (22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull body skin exam not in the setting of immunosuppressive IBD therapy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e10 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e5 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e5 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDermatologic condition traditionally considered unrelated to IBD\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eIncludes acne vulgaris, rosacea, nonmelanoma skin cancer, alopecia (areata, androgenic, telogen effluvium), seborrheic dermatitis, viral warts, fungal infection, lichenoid dermatosis, contact dermatitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e92 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e55 (20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e32 (27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e5 (22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis Made at Initial Dermatology Visit, N (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall Prevalence (n=401)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrohn\u0026rsquo;s Disease\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=263)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUlcerative Colitis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=116)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndeterminate Colitis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=22)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecific cutaneous manifestation of IBD\u003c/strong\u003e+\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e51 (12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e43 (16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e5 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e3 (13.6)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReactive cutaneous manifestation of IBD\u003c/strong\u003e+\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e13 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e9 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e3 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e1 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCutaneous manifestation associated with IBD\u003c/strong\u003e\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e123 (30.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e89 (33.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e27 (23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e7 (31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCutaneous manifestation due to adverse effect of IBD treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e72 (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e54 (20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e16 (13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e2 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRash or lesion not otherwise specified\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e3 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e2 (0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e1 (0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDermatologic condition traditionally considered unrelated to IBD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e207 (51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e131 (49.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e63 (54.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e13 (59.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.6786%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo diagnosis made\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e53 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e30 (11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.75%;\"\u003e\n \u003cp\u003e22 (18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.9643%;\"\u003e\n \u003cp\u003e1 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eBenign variant skin findings (e.g., melanocytic nevi, seborrheic keratoses, keratosis pilaris) were not counted as diagnoses unless bothersome to the patient or requiring treatment.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e+\u003c/sup\u003eReactive lesions include immunologically mediated cutaneous manifestations related to underlying IBD; specific share histopathologic features with intestinal disease; and associated conditions with increased prevalence in patients with IBD.\u003c/p\u003e\n\u003cp\u003eNote: \u0026ldquo;Average time since IBD diagnosis \u0026plusmn; SD, years\u0026rdquo; refers to patients with an established IBD diagnosis at their first dermatology visit. \u0026ldquo;Average time to IBD diagnosis \u0026plusmn; SD, years\u0026rdquo; refers to patients who received a new IBD diagnosis after their initial dermatology visit.\u003c/p\u003e\n\u003cp\u003eAbbreviations: IBD, inflammatory bowel disease; SD, standard deviation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Summary of Management Strategies and Dermatologic Outcomes Among Patients with IBD Treatment-Associated Cutaneous Disease (n = 72).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"672\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal, N\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParadoxical psoriasis or eczema (N=37)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBacterial skin infection (N=27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrug-induced acne (N=8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContinued therapy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e52\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e21\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003eComplete resolution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e14\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003ePartial resolution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e14\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003eStable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e8\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003eProgressive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e18\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSwitched therapy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003eComplete resolution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003ePartial resolution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e10\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003eStable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003eProgressive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiscontinued therapy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003eComplete resolution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003ePartial resolution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22.3214%;\"\u003e\n \u003cp\u003eStable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.8571%;\"\u003e\n \u003cp\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.6429%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.5357%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Inflammatory bowel disease, Cutaneous extraintestinal manifestations, Paradoxical cutaneous reactions, Crohn’s disease, Ulcerative colitis","lastPublishedDoi":"10.21203/rs.3.rs-8628611/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8628611/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDermatologic 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\u0026rsquo;s disease, ulcerative colitis, or indeterminate colitis evaluated at their initial visit in a dedicated IBD\u0026ndash;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.\u003c/p\u003e \u003cp\u003eDermatologic 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\u0026ndash;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.\u003c/p\u003e \u003cp\u003eParadoxical psoriasiform and eczematous eruptions, most often associated with anti\u0026ndash;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.\u003c/p\u003e \u003cp\u003eDermatologic 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\u0026ndash;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.\u003c/p\u003e","manuscriptTitle":"Dermatologic disease in Inflammatory Bowel Disease: a 10-year, 401-patient cohort from a dedicated IBD– Dermatology Program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 06:53:25","doi":"10.21203/rs.3.rs-8628611/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"129208788700323336576109362036772035429","date":"2026-02-16T16:08:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-10T19:39:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-19T11:16:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-19T11:13:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Dermatological Research","date":"2026-01-18T00:31:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b488b37c-ca29-497b-92f2-b52220859ffe","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T06:53:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 06:53:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8628611","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8628611","identity":"rs-8628611","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}