Tacrolimus should not be applied to ulcerated tissue, as it has been reported to be toxic.Īntiseptic cleansers containing chlorhexidine can reduce secondary infection in any persisting folds or skin fissures. Mild Crohn disease is often treated with potent topical corticosteroid ointments or calcineurin inhibitors ( tacrolimus ointment or pimecrolimus cream). Genital sarcoidosis (another cause of granulomas).Idiopathic genital lymphoedema (with or without obesity).Genital cellulitis and other infections.Other skin conditions affecting the genital area may appear similar to genital Crohn disease. What is the differential diagnosis of genital Crohn disease? Swabs should be taken to determine whether there is a bacterial and yeast infection. They are useful where there is doubt about the diagnosis or lack of response to treatment. For this reason, biopsies are not always performed. These are not always seen because the granulomas can be quite localised and so get missed. Skin biopsy in Crohn disease will often show c hronic inflammation with noncaseating granulomas. Genital Crohn disease should be considered as a diagnosis in anyone with a history of inflammatory bowel disease that presents with fissures, ulcers, fistulas and swelling of the genitals.Īs skin symptoms can predate bowel disease, genital Crohn disease should also be considered in people with these symptoms that do not have a history of bowel disease 20–35% of patient with genital Crohn disease do not have gastrointestinal symptoms or disease. Pustules and abscesses similar to those seen in hidradenitis suppurativa.Secondary bacterial infection or Candida albicans infection.Flare-ups of genital and perianal Crohn disease, which may result in painful red papules, plaques or ulcers.The lymphoedema tends to get more severe with each flare-up, resulting in distortion of the normal anatomy of the genitals. Males less commonly develop swelling of the penis and scrotum. Females commonly present with swelling of the labia on one or both sides. This is known as granulomatous lymphangiopathy or lymphoedema. Genital swelling in Crohn disease is due to Crohn granulomas blocking the lymph vessels. Fistulas may also involve perianal skin, genital skin, the vagina or the vulva. These arise most often when Crohn disease affects the rectum (large bowel). Fistulas or tunnelsįistulas or tunnels may form joining the diseased bowel to the skin.
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Full skin thickness ulceration may occur. These fissures and erosions cause soreness or discomfort on urination and may disrupt or prevent normal sexual activity. Fissures and erosionsĬracks and erosions arise in the groin creases, around the anus, in between the buttocks, in the folds of the vulva in females and on the foreskin or around the scrotum in males. Genital Crohn disease may present with any or all of the following features. What are the features of genital Crohn disease? Eye inflammation (episcleritis or anterior uveitis).Orofacial granulomatosis (granulomatous Crohn disease in the mouth or elsewhere on the face).
Other skin problems associated with Crohn disease can arise at the same time as granulomatous genital Crohn disease. Severe genital disease affects fewer than 8% of people with significant intestinal disease, in the author's experience. Mild genital skin changes such as fissures are relatively common in patients with moderate to severe intestinal Crohn disease. However, it can occur months or even years before the onset of bowel symptoms or at any time afterwards. When genital Crohn disease arises, it is diagnosed at the same time as the intestinal Crohn disease in > 50% of cases. Who gets genital Crohn disease?Ĭrohn disease, including genital involvement, can occur at any age the genital disease is more common in females (a 2:1 ratio). Granulomatous genital Crohn disease results in a variety of skin problems, but most often fissures (skin splits). The skin disease can join up with the bowel disease or be completely separate (in this case it is called metastatic Crohn disease). Genital Crohn disease describes the skin condition that arises when granulomas affect the genitals and adjacent skin.
Crohn disease is an inflammatory bowel disease patients develop granulomas and ulcers in the bowel.
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