https://www.gastrojournal.org/article/0016-5085(80)90155-9/pdf

Healing of perineal Crohn's disease with metronidazole.

Critical to the proper management of pyoderma gangrenosum are correct diagnosis, identification and treatment of any underlying disorder, and the proper choice of topical and systemic therapy. Many agents are available for the treatment of pyoderma gangrenosum. We review the current therapeutic options, their efficacy and side effects, and we offer some guidelines for their proper selection.

Treatment of pyoderma gangrenosum

Crohn's disease is a chronic inflammatory bowel disease which may have distinctive mucocutaneous manifestations. Included in this group are perianal, peristomal, and perifistular ulceration, as well as granulomatous cutaneous inflammation separate from gastrointestinal tract openings (metastatic Crohn's disease). In the oral cavity, both ulcerations and granulomatous nodules may occur. Malabsorption of nutrients may lead to several changes, including an acrodermatitis enteropathica–like syndrome secondary to zinc deficiency. Patients with Crohn's disease may also have pyoderma gangrenosum, erythema nodosum, cutaneous vasculitis, and other less specific changes.

https://www.jaad.org/article/S0190-9622(81)70130-0/pdf

Cutaneous manifestations of Crohn's disease

This paper describes in detail seven cases of extensive perineal ulceration seen in 207 cases of Crohn's disease at St Mark's Hospital in the last eight years. Four of these cases also had cutaneous ulceration elsewhere. Suggestions are made for the management of further cases of this rare condition.

https://gut.bmj.com/content/gutjnl/11/1/18.full.pdf

Cutaneous ulceration in Crohn's disease

Metastatic Crohn's disease is a term used to describe a granulomatous reaction occurring in flexures, and separated from the affected areas of the gastro-intestinal tract by normal skin. Previous reports refer to such lesions affecting the groins, the male genitalia, a flexure on the anterior abdominal wall of an obese patient, and submammary regions. A further case, in which the retro-auricular areas are involved, is presented.

Metastatic Crohn's disease

M Y, female, aged 70 In 1959 this patient began to have diarrheea, with discharge of mucus and blood. She was admitted to the London Hospital under the care of Professor J M Ledingham. In the first instance she was treated conservatively and this included steroid therapy. In 1961 a subtotal colectomy and ileostomy was performed. The rectum was not removed. Pathological examination ofthe specimen revealed the typical changes of Crohn's disease, maximal in the distal colon. In January 1963 she had an attack of intestinal obstruction. This subsided spontaneously, but active disease in the rectal stump began to cause symptoms. At this time there was considerable excoriation of the anal skin with two fistuli and large tags. The excision of the rectum was carried out on January 18, 1963. Her course was uneventful except that the perineal wound remained indolent and did not heal. For about six months she remained well apart from discharge from the unhealed perineal wound. Then the inflammation in the old wound began to extend forwards to both groins. She was admitted to St Mark's Hospital in October 1963. Her general condition was good. There was indolent ulceration in the natal cleft, extending in the fourchette and up i)to the inguinal regions on both sides. There were also non-ulcerative lesions on both lower legs. Biopsies from various areas were reported on as follows: 'There were collections of giant cells and epithelioid cells which strongly suggest sarcoid reaction. The appearances support tile clinical diagnosis of Crohn's disease.'

B C Morson

Papers

Crohn's disease with cutaneous involvement.