BI25 Inflammatory bowel disease and dermatology: a single-centre cohort review

Abstract Skin disease affects up to 15% of patients with inflammatory bowel disease (IBD), most commonly in patients with active disease and a positive family history, and it can precede IBD diagnosis. Inflammatory skin diseases, such as atopic eczema, hidradenitis suppurativa (HS) and psoriasis, frequently coexist in this population, although they are not commonly considered associations of IBD. Such diseases in coexistence with IBD can be complex and severe, requiring tertiary specialist involvement. We aimed to analyse and report clinical data collected from our tertiary centre joint gastroenterology–dermatology clinic (GDC) to describe common clinical presentations and management. We reviewed the electronic health records of patients seen within the GDC between July 2021 and July 2024, collecting demographic and clinical data. Sixty-six patients attended 15 joint clinics over the 3-year period. The majority were female (71%, n = 47), and the median age was 37 years (range 18–78). A diagnosis of IBD was present in 91% of patients reviewed (n = 60), including Crohn disease (CD) (n = 49, 74%), ulcerative colitis (n = 10, 15%) and orofacial granulomatosis (n = 1, 1%). Around one-half (48%) of patients with CD did not smoke, compared with 100% of patients with ulcerative colitis. The CD phenotype was largely ileocolonic or colonic inflammatory disease, with a high volume of perianal disease present. Other gastroenterological diseases included lymphocytic colitis (n = 1), bile acid malabsorption (n = 1), coeliac disease (n = 1) and mast cell activation syndrome (n = 1). The most common dermatological diseases were hidradenitis suppurativa (n = 20, 30%), atopic eczema (n = 12, 18%), psoriasis (n = 19, 29%), cutaneous CD (n = 11, 17%) and neutrophilic dermatoses (Sweet syndrome, bowel-associated dermatitis–arthritis syndrome, or pyoderma gangrenosum; n = 6, 9%). One-fifth of patients with psoriasis had genital or perineal involvement and five patients had paradoxical psoriasis secondary to anti-tumour necrosis factor therapy. Fifty-five patients (83%) had biologic or advanced therapy prescribed, and proactive management or investigation decisions were made during most clinic visits. Nineteen patients (35%) switched advanced therapies through the GDC, with reasons including poor gastroenterological (32%) or dermatological (21%) disease control, both poor dermatological and gastroenterological disease control (16%) and paradoxical dermatological disease development (16%). This study highlights the complexity of dermatological disease present within a cohort of patients with IBD, driven by overlapping mechanisms. Through a joint clinic approach, enabling simultaneous review by a dermatologist and gastroenterologist, prompt initiation of appropriate advanced therapy can be carried out, often aimed to address both specialty diagnoses. We encourage other centres to adopt such a clinic model to coordinate and streamline care for this challenging patient population.