Introduction
Enteritis is most commonly caused by eating food infected with bacteria or viruses. The germs settle within the intestine and tend to cause infection, leading to inflammation and swelling. Since enteritis colitis primarily affects the gastrointestinal tract, it leads to abdominal pain, diarrhea, and rectal bleeding. When this condition is associated with inflammatory bowel diseases like Crohn’s disease or ulcerative colitis, there can be extraintestinal manifestations, including those of the skin. It is essential to note that the skin symptoms are not exclusive to enteritis colitis but can occur conjugally with inflammatory bowel diseases or other gastrointestinal conditions.
How Common Are Skin Symptoms in Individuals With Enteritis Colitis?
The skin symptoms of enteritis colitis, particularly those associated with inflammatory bowel disease (IBD), are relatively prevalent. Inflammatory bowel diseases (IBD) include Crohn’s disease and ulcerative colitis. Crohn's disease is an inflammatory gastrointestinal tract disease that causes chronic inflammation. Studies have shown that about 15 to 20 percent of individuals with IBD tend to develop extraintestinal manifestations that include even skin symptoms. However, the exact prevalence varies depending on the population being studied and the severity of the underlying gastrointestinal diseases and other factors. The skin symptoms are not commonly associated with enteritis colitis and may not occur in every case. The type and severity of the skin symptoms may also vary among the individuals. Some may experience a mild rash or irritation, while others may develop more severe conditions like erythema nodosum (inflammatory condition affecting the fat cells under the skin) and pyoderma gangrenosum (rare skin condition resulting in painful ulcers).
What Are Some Typical Skin Manifestations Associated With Enteritis Colitis?
The skin manifestations associated with enteritis colitis, particularly those associated with inflammatory bowel diseases like Crohn’s disease and ulcerative colitis, erythema nodosum, are characterized by red, tender, and painful nodules that typically appear on the shine. It can occur during disease flare-ups. Pyoderma gangrenosum usually resembles a spider bite and starts as a small, red bump on the skin; within a few days, this can develop into a large, painful, open sore. This ulcer can develop anywhere on the body but is mostly associated with the legs; at times, it also appears around surgical sites. Dermatitis and various forms of it are experienced by those with enteritis colitis, such as rashes, psoriasis-like rash, and generalized skin inflammation. These skin manifestations are related to autoimmune processes, nutritional deficiency, and side effects of medications. Aphthous stomatitis is a mouth ulcer that can be associated with individuals with inflammatory bowel diseases like Crohn’s disease and ulcerative colitis. Cutaneous vasculitis can occur in some individuals with enteritis colitis; symptoms like purpura, petechiae (tiny bleeding spots), and larger skin lesions can be seen.
Which Specific Skin Symptoms Are More Commonly Seen in Crohn’s Disease Versus Ulcerative Colitis?
Although both Crohn's disease and ulcerative colitis are a form of inflammatory bowel disease (IBD), there exist differences in the specific skin symptoms, which are more commonly associated with each condition. In Crohn's disease, erythema nodosum, pyoderma gangrenosum, perineal skin tags, and ulcers are seen. These skin tags primarily affect the perianal area leading to the development of skin tags and fistula around the anus. The skin symptoms are less commonly associated with ulcerative colitis. While still rare, pyoderma gangrenosum can occur in some individuals with ulcerative colitis, but it is less common. Mucocutaneous manifestations include mouth ulcers and specific types of dermatitis, including erythema multiforme and epidermolysis bullosa acquisita. However, the skin symptoms may not be commonly associated.
How Do Skin Symptoms Impact the Overall Management and Prognosis of Enteritis Colitis?
These skin symptoms can impact the diagnosis and prognosis in several ways; skin symptoms can be the first indication of underlying enteritis colitis, especially in those cases where the gastrointestinal symptoms are absent or mild. Recognizing and evaluating the skin manifestations can prompt clinicians to establish earlier diagnoses and interventions. The skin symptoms would require specific treatment approaches and therapies for managing underlying enteritis colitis. Medications such as corticosteroids, immunomodulators, or biologic agents may address gastrointestinal symptoms and skin manifestations. The skin symptoms can affect the quality of life by causing pain, discomfort, and cosmetic concerns. Persistent and severe skin manifestations can indicate more severe disease and require close monitoring to prevent complications. Skin symptoms quite significantly create a psychological impact. It tends to affect self-esteem, body language, and mental health.
Can Skin Symptoms Precede Gastrointestinal Symptoms in Some Cases of Enteritis Colitis?
In some cases of enteritis colitis, the skin symptoms can precede GIT symptoms. This phenomenon is known as extraintestinal manifestations (EIM). There are several reasons why this happens. IBD can have a very diverse range of clinical presentations, but not all individuals will experience GIT symptoms as the initial manifestations of the disease.
A dysregulated immune response tends to affect the GIT track and skin, leading to the development of skin symptoms before the GIT symptoms. Certain genetic factors may also influence the expression of extraintestinal manifestations, including skin symptoms. Genetic influences may contribute to variability in the timing and presentation of skin and the GIT symptoms. Environmental triggers such as stress, diet, and microbial exposures can influence the onset of both the skin and GIT symptoms.
Are Any Specific Diagnostic Tests or Procedures Used to Evaluate Skin Manifestations in Individuals With Enteritis Colitis?
There are specific diagnostic tests and procedures to evaluate the skin manifestations in individuals. A thorough physical examination by the healthcare provider, including skin and mucous membranes, is necessary. The skin lesion's appearance, characteristics, and distribution can provide valuable clues to the underlying condition. A biopsy must be done when skin lesions are not attributable. Blood tests may be done to assess the markers of inflammation, autoimmune activity, or nutritional deficiencies, which could be contributing to the skin manifestations. The tests may include C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), antinuclear antibody, and vitamin levels. Skin cultures must be done if there is suspicion of skin infections, like bacterial abscesses and cellulitis. Imaging studies like ultrasound and magnetic resonance imaging may also be done to assess the extent of skin involvement. For complex and refractory skin manifestations, consultation with a dermatologist is warranted.
Conclusions:
There should be a multidisciplinary approach to management, which involves gastroenterologists, dermatologists, and other healthcare providers. A tailored treatment strategy must address the GIT and skin manifestations to effectively and strategically manage the associated skin symptoms. Not all symptoms lead to skin manifestation; hence, knowing the condition in depth is essential to resolve it better.
