CLINICAL AND DERMATOLOGICAL MANIFESTATIONS OF CROHN'S DISEASE IN IMMUNOSUPPRESSED PATIENTS

Abstract

Crohn's disease (CD) is a chronic inflammatory intestinal disease, with multifactorial etiology, which can affect any segment of the gastrointestinal tract, being more common in the terminal ileum and colon. CD is characterized by transmural inflammation, which can cause complications such as strictures, fistulas, abscesses and perforations. Specific dermatological manifestations include erythema nodosum, pyoderma gangrenosum, oral and genital aphthae, and cutaneous metastases of CD. Nonspecific manifestations include psoriasis, acne, eczema, seborrheic dermatitis, vitiligo, among others. Patients with CD may require immunosuppressive treatments, such as corticosteroids, immunomodulators and biological agents, to control inflammation and induce disease remission. However, these treatments can increase the risk of infections, adverse reactions and neoplasms, which can affect the skin and other organs. Objective: to evaluate the scientific evidence on the clinical and dermatological manifestations of Crohn's disease in immunosuppressed patients, as well as the treatments and outcomes of these patients. Methodology: A search was carried out in the PubMed, Scielo and Web of Science databases, using the following descriptors: “Crohn disease”, “immunosuppression”, “skin manifestations”, “dermatology” and “treatment”. Articles published in the last 10 years, in Portuguese, English or Spanish, that addressed the clinical and dermatological manifestations of CD in immunosuppressed patients, as well as the treatments and outcomes of these patients, were included. Articles that were not original, that were unrelated to the topic, that had low methodological quality or that were not available in full were excluded. Data synthesis was carried out in a narrative manner, following the PRISMA checklist for reporting systematic reviews. Results: 15 articles were identified. The most frequent clinical manifestations of CD were diarrhea, abdominal pain, weight loss and fever. The most frequent dermatological manifestations were erythema nodosum, pyoderma gangrenosum, oral and genital aphthae, and psoriasis. The most commonly used immunosuppressive treatments were corticosteroids, azathioprine, methotrexate, infliximab, adalimumab and Certolizumab. The outcomes evaluated were clinical and dermatological response, disease remission, quality of life, infections, adverse reactions and mortality. The results showed that immunosuppressive treatments were effective in controlling inflammation and inducing CD remission, as well as improving dermatological manifestations, especially erythema nodosum and pyoderma gangrenosum. However, these treatments have also been associated with an increased risk of infections, particularly from mycobacteria, fungi and viruses, which can cause serious and potentially fatal skin lesions. Furthermore, some immunosuppressive treatments, such as biological agents, can induce or worsen other dermatological manifestations, such as psoriasis, acne and eczema. Studies have also reported cases of skin neoplasms, such as melanoma and basal cell carcinoma, in immunosuppressed CD patients. Conclusion: The clinical and dermatological manifestations of Crohn's disease in immunosuppressed patients are diverse and challenging, requiring a multidisciplinary and individualized approach. Immunosuppressive treatments can be beneficial for controlling inflammation and improving dermatological manifestations, but they can also increase the risk of infections, adverse reactions and neoplasms, which can affect the skin and other organs. Therefore, strict monitoring and periodic assessment of the risks and benefits of immunosuppressive treatments in patients with CD are necessary. More studies are needed to establish the best strategies for prevention, diagnosis and treatment of dermatological manifestations of CD in immunosuppressed patients.