The risk of later diagnosis of inflammatory bowel disease in patients with dermatological disorders associated with inflammatory bowel disease

Research output: Contribution to journalArticlepeer-review


  • Dominic King
  • Joht Singh Chandan
  • Tom Thomas
  • Nigel Trudgill


Introduction: Dermatological conditions such as erythema nodosum (EN), pyoderma gangrenosum (PG), Sweet’s syndrome and aphthous stomatitis can occur with inflammatory bowel disease (IBD) and are considered dermatological extraintestinal manifestations (D-EIMs). Rarely they may precede IBD. Other common conditions such as psoriasis have also been associated with IBD. This study examined the risk of a subsequent IBD diagnosis in subjects presenting with a D-EIM.

Methods: A retrospective cohort study compared subjects with D-EIMs and age/sex-matched subjects without D-EIMs. Hazard ratios (HR) were adjusted for age, sex, body mass index, deprivation, comorbidity, smoking, loperamide use, anaemia and lower gastrointestinal symptoms. Logistic regression was used to produce a prediction model for the diagnosis of IBD within 3-years of EN diagnosis.

Results: 7,447 subjects with D-EIMs (74% female, median age 38 (IQR 24-65) years) were matched to 29,297 subjects without D-EIMs. 131 (1.8%) subsequent IBD diagnoses were observed in those with D-EIMS compared to 65 (0.2%) in those without. Median time to IBD diagnosis was 205 (IQR 44-661) days in those with D-EIMs and 1,594 (693-2,841) in those without. The adjusted HR for later diagnosis of IBD was 6.16 (95%CI 4.53-8.37),p<0.001; for ulcerative colitis 3.30 (1.98-5.53),p<0.001 and for Crohn’s disease 8.54 (5.74-12.70),p<0.001. Subjects with psoriasis had a 34% increased risk of a subsequent IBD diagnosis compared to matched controls (1.34 (1.20-1.51), p<0.001).4,043 subjects with an incident EN diagnosis were included in the prediction model cohort with 87 (2.2%) diagnosed with IBD within 3-years. The model had a bias-corrected c-statistic of 0.82 (95% CI 0.78-0.86).

Conclusions: Subjects with D-EIMs have a six-fold increased risk of later diagnosis of IBD. Younger age, smoking, low BMI, anaemia and lower gastrointestinal symptoms were associated with increased risk of diagnosis of IBD within 3-years in subjects with EN


Original languageEnglish
JournalInflammatory Bowel Diseases
Early online date9 Jan 2021
Publication statusE-pub ahead of print - 9 Jan 2021


  • extra intestinal manifestations, inflammatory bowel disease, Crohn’s disease, ulcerative colitis, erythema nodosum, pyoderma gangrenosum, psoriasis, aphthous stomatitis, Sweet’s syndrome, dermatological