Genital Crohn's disease

What is genital Crohn's disease?

Crohn's disease is a inflammatory gastrointestinal disease; patients develop granulomas and ulcers in the intestine Genital Crohn's disease describes the skin condition that arises when granulomas affect the genitals and adjacent skin. The skin disease can be linked to the intestinal disease or be completely separate (in this case it is called metastatic Crohn's disease).

Granulomatous Genital Crohn's disease causes a variety of skin problems, but most often fissures (skin splits).

Who gets genital Crohn's disease?

Crohn's disease, including genital involvement, can occur at any age; Genital disease is more common in women (a ratio of 2: 1).

When genital Crohn's disease arises, it is diagnosed at the same time as intestinal Crohn's disease in >50% of cases. However, it can occur months or even years before the onset of bowel symptoms or at any time afterward.

Mild changes in the genital skin, such as fissures, are relatively common in patients with moderate to severe intestinal Crohn's disease. Severe genital disease affects less than 8% of people with significant bowel disease, in the author's experience.

Other skin problems associated with Crohn's disease can occur at the same time as granulomatous genital Crohn's disease. The most common are:

• Pyoderma gangrenous

• Orofacial granulomatosis (granulomatous Crohn's disease in the mouth or elsewhere on the face)

• Hidradenitis suppurativa

• Erythema knotty
• Eye inflammation (epiescleritis or previous uveitis)
• sero negative arthropathy.

What are the characteristics of genital Crohn's disease?

Genital Crohn's disease may present with any or all of the following features.

cracks and erosions

Cracks and erosions arise in the groin folds, around the anus, between the buttocks, in the folds of the vulva in females and on the foreskin or around the scrotum in males. They are called 'knife cut' fissures. These fissures and erosions cause pain or discomfort when urinating and can interrupt or prevent normal sexual activity. Full skin thickness ulceration it can happen.

fistulas or tunnels

Fistulas or tunnels can form that join the diseased intestine with the skin. These arise most often when Crohn's disease affects the rectum (large intestine). Fistulas can also involve perianal skin, genital skin, vagina or vulva.

persistent swelling

Genital swelling in Crohn's disease is due to Crohn's granulomas blocking lymphatic vessels. This is known as granulomatous lymphangiopathy or lymphedema. Females usually have lip swelling on one or both sides. Males less often develop swelling of the penis and scrotum. Lymphedema tends to worsen with each outbreak, resulting in distortion of the normal anatomy of the genitalia. It can persist in the long term.

Other features

• Skin tags
• Flare-ups of genital and perianal Crohn's disease, which can cause painful redness papules, plates or ulcers
• Secondary bacterial infection or Candida albicans infection
• Pustules and abscesses similar to those seen in hidradenitis suppurativa

See images of genital Crohn's disease.

How is genital Crohn's disease diagnosed?

Genital Crohn's disease should be considered as a diagnosis in anyone with a history of inflammatory bowel disease presenting with fissures, ulcers, fistulas, and swelling of the genitalia.

Because cutaneous symptoms may predate intestinal disease, genital Crohn's disease should also be considered in persons with these symptoms who do not have a history of intestinal disease; 20 to 35% of patients with genital Crohn's disease have no symptoms or gastrointestinal disease.

Skin biopsy Chronic inflammation with noncaseating granulomas is often present in Crohn's disease. These are not always seen because granulomas can be quite located and that they miss you.

Poor healing is common in Crohn's disease. For this reason, biopsies They are not always done. They are useful when there are doubts about the diagnosis or lack of response to treatment.

Swabs should be taken to determine if there is a bacterial and yeast infection.

Which is the differential diagnosis of genital Crohn's disease?

Other skin conditions that affect the genital area may appear similar to genital Crohn's disease. These include:

• Genital cellulitis and other infections.
• Idiopathic genital lymphedema (with or without obesity)
• Hidradenitis suppurativa
• Gangrenous pyoderma
• Genital sarcoidosis (another cause of granulomas).

How is genital Crohn's disease treated?

Mild Crohn's disease is often treated with powerful current corticosteroid ointments or calcineurin inhibitors (tacrolimus ointment or pimecrolimus cream) Tacrolimus should not be applied to ulcerated tissue as it has been reported to be toxic.

Antiseptic cleansers containing chlorhexidine can reduce secondary infection in any persistent folds or fissures. Antibiotics are prescribed for invader skin infection (cellulitis). Topical antifungal creams and oral antifungal agents are prescribed for a yeast infection (Candida albicans or thrush).

Active genital Crohn's disease with lymphedema requires systemic therapy. This can be incorporated into the treatment regimen for the underlying intestinal Crohn's disease. Agents used include:

• oral metronidazole
• Azathioprine
• Methotrexate
• TNF-alpha inhibitors such as infliximab or adalimumab (biologic therapies).

Compression underwear, such as those worn in sports and cycling, can reduce lymphedema. Surgery may be required to remove redundant folds of skin, particularly from the labia minora.

Darvadstrocel, a local delivery of stem cells derived from expanded adipose tissue, has received marketing authorization in Europe for the treatment of perianal complex fistula In some circumstances.