Systematic review of the clinical features and treatment modalities for metastatic Crohn’s disease

Background Metastatic Crohn’s disease (MCD), also known as cutaneous Crohn’s disease and genital Crohn’s disease, is a rare cutaneous manifestation of Crohn’s disease (CD). Descriptions of clinical features, patient demographics and treatment options are limited. Objective To collate the published evidence on clinical features, patient demographics and treatment strategies for MCD to aid diagnosis and potential treatment algorithms. Method We systematically searched EMBASE, Medline, CINAHL and Cochrane databases from inception to April 2025 for all publications reporting on MCD, with no language restrictions. Review articles and commentaries were excluded. We present a descriptive synthesis of the results. Results We identified 230 studies and a total of 610 patients (161 males, 449 females). Genital erythema and oedema were hallmark clinical features. Women were affected more than men, with younger patients more likely to be affected. There was an association with colonic phenotype and peri-anal CD. However, MCD predated a luminal CD diagnosis in one third of cases. Treatments ranged from topical, systemic and surgical modalities with anti-TNF therapy being the most reported therapy. Conclusions One-third of patients with MCD did not have a diagnosis of luminal or perianal CD. MCD was predominantly diagnosed in younger women and affected the genitalia, progressing to involve other sites such as the perineum and groin. Ulceration is a feature of aggressive disease involving multiple sites. There is a clear need for standardised reporting, treatment guidelines and prospective interventional trials to enable evidence-based recommendations.