S2016 Comparative Analysis of Non-Malignant Skin Lesions in Crohn’s Disease and Ulcerative Colitis: Results From a Population-Based Study

Introduction: Cutaneous manifestations are common extraintestinal findings in inflammatory bowel disease (IBD); however, comparative data between Crohn’s disease (CD) and ulcerative colitis (UC) remain limited. We aimed to assess the prevalence and demographic associations with inflammatory bowel disease (IBD) using a large, real-world cohort. Methods: A cross-sectional analysis was performed using TriNetX, a federated, de-identified electronic health record network. Adults (≥18 years) with at least 2 instances of International Classification of Diseases-10 codes for CD (K50) or UC (K51) were included. Patients with dual diagnoses or malignancies were excluded. Non-malignant skin lesions were identified through the use of International Classification of Diseases-10 codes for psoriasis, hidradenitis suppurativa, erythema nodosum, pyoderma gangrenosum, vitiligo, oral aphthae, Sweet syndrome, and skin tags. Comparisons were made using chi-square and t-tests. Results: Among 108,775 CD and 121,035 UC patients, 7.7% and 8.4%, respectively, had non-malignant skin lesions. CD patients were younger (mean 48.6 vs 54.5 years, P < 0.001), with more patients aged <40 years (32.7% vs 21.2%), whereas UC patients had more patients aged ≥65 (31.9% vs 19.5%, P < 0.001). The majority of the IBD patients with non-malignant skin lesions in both cohorts were White (71% CD vs 70% UC). Skin tags were the most common cutaneous manifestation (59.6% CD, 68.8% UC), followed by hidradenitis suppurativa, oral aphthae, and psoriasis. Patients with CD were more likely to have pyoderma gangrenosum (3.9%), hidradenitis suppurativa (12.4%), and erythema nodosum (3.4%), whereas patients with UC were more likely to have vitiligo (2.5%). There was no difference in prevalence between CD and UC for recurrent oral aphthae, psoriasis vulgaris, or febrile neutrophilic dermatosis. Conclusion: The non-malignant cutaneous manifestations are common in IBD and differ in CD and UC. These findings emphasize the importance of appropriate characterization and management of skin lesions in this population.