Management of patients with inflammatory bowel diseases and extra-intestinal skin manifestations

Introduction. Clinical manifestations of inflammatory bowel diseases (IBD) are limited not only by the gastrointestinal tract syndromes, but also by a wide range of extra-intestinal manifestations, which include skin manifestations. Skin lesions in IBD occur in different forms. Some of them are associated with the activity of the main process, for example, gangrenous pyoderma. Others, such as psoriasis, are combined with pathogenetic factors common to IBD. Materials and methods. Three clinical observations of patients with IBD and extra-intestinal manifestations are presented: gangrenous pyoderma (case 1) and psoriasis (cases 2, 3). The stages of differential diagnostic search and treatment are described. The interleukin 12/23 inhibitor ustekinumab is prescribed to both bionaive patients (observations 1, 2), and to the patient who (observation 3) had high activity of the inflammatory process in the intestine and had received early treatment with GEBD. The extension of indications for use ustekinumab (ulcerative colitis, Crohn’s disease, psoriasis, psoriatic arthritis) of allows for its wider use in the treatment of patients. Conclusion. The interleukin 12/23 inhibitor ustekinumab has broad indications for use; its use allows to achieve a positive clinical, laboratory and endoscopic effect at the early stages of use. This effect has spread to skin manifestations, the reduction of which occurs in parallel with the healing of the intestinal mucosa.

inflammatory bowel diseases (IBD) extra-intestinal manifestations, skin lesions, gangrenous pyoderma, psoriasis, ustekinumab, clinical case

1. Alexandrov T.L., Khalif I. L., Khalif A. Yu., Khismatullina Z. R., Shapina M. V. Skin diseases and inflammatory bowel diseases. Literature review. Meditsinskiy sovet = Medical Council. 2020;(5):114-119. (In Russ.) doi: 10.21518/2079-701X-2020-5-114-119.@@ Александров Т. Л., Халиф И. Л., Халиф А. Ю., Хисматуллина З. Р., Шапина М. В. Болезни кожи и воспалительные заболевания кишечника. Обзор литературы. Медицинский совет. 2020;(5):114-119. doi: 10.21518/2079-701X2020-5-114-119.

2. Crohn’s disease. Clinical guidelines, 2020. Available at: https://www.cr.minzdrav.gov.ru. (Accessed: 29.09. 2022.) (in Russ.)@@ Болезнь Крона. Клинические рекомендации, 2020. Режим доступа: https://www.cr.minzdrav.gov.ru. (Дата обращения 2.08. 2022)

3. Inflammatory bowel disease. Clinical guide / edd. Deniel Dzh. Shtayn, Reza Sheyker; transl. I. L. Khalif. Moscow. GEOTAR-Media, 2021. 256 Р. (in Russ.)@@ Воспалительные заболевания кишечника. Клиническое руководство / ред. Дэниэл Дж. Штайн, Реза Шейкер; пер. с англ.под ред. И. Л. Халифа. - Москва: ГЭОТАР-Медиа, 2021. - 256 с.

4. Kudishina M. M., Kozlova I. V. Extraintestinal manifestations of inflammatory bowel diseases. Effektivnaya farmakoterapiya. 2019; (18): 52-58. (In Russ.) doi: 10.33978/2307-3586-2019-15-18-52-58.@@ Кудишина М. М., Козлова И. В. Экстраинтестинальные проявления воспалительных заболеваний кишечника. Эффективная фармакотерапия. 2019; (18): 52-58. doi: 10.33978/2307-3586-2019-15-18-52-58.

5. Adaskevich V. P. Gangrenous pyoderma: the current state of the problem. ConsiliumMedicum. 2021; 23 (8): 603-608. (In Russ.) doi: 10.26442/20751753.2021.8.201054.@@ Адаскевич В. П. Гангренозная пиодермия: современное состояние проблемы. ConsiliumMedicum. 2021; 23 (8): 603-608. doi: 10.26442/20751753.2021.8.201054.

6. Kruglova L.S., Lvov A. N., Kagramanova A. V., Knyazev O. V. Psoriasis and inflammatory bowel diseases: pathogenetic pathways and the choice of biologic therapy (a literature review). Almanac of Clinical Medicine. 2019;47(6):568-78. (In Russ.) doi: 10.18786/2072-0505-2019-47-062.@@ Круглова Л. С, Львов А.Н, Каграманова А.В, Князев О. В. Псориаз и воспалительные заболевания кишечника: пути патогенеза и вопросы выбора генно-инженерных препаратов (обзор литературы). Альманах клинической медицины. 2019;47(6):568-78. doi: 10.18786/2072-0505-2019-47-062

7. Abdulganieva D.I., Bakulev A. L., Belousova E. A., et al. Early prescription of biological agents for immune-mediated inflammatory diseases: opportunities and prospects. An expert’s opinion. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2020;14(3):7-18. (In Russ.) doi: 10/14412/1996-7012-2020-3-7-18.@@ Абдулганиева Д. И., Бакулев А. Л., Белоусова Е. А. и др. Раннее назначение генно-инженерных биологических препаратов при иммуновоспалительных заболеваниях: возможности и перспективы. Позиция экспертов. Современная ревматология. 2020;14(3):7-18. doi: 10.14412/1996-7012-2020-3-7-18.

8. Makarchuk P.A., Lomakina E. Yu., Belousova E. A. Ustekinumab in patients with Crohn’s disease with extraintestinal manifestations (psoriasis). Meditsinskiy sovet = Medical Council. 2020;(15):121-126. (In Russ.) doi: 10.21518/2079-701X-2020-15-121-126.@@ Макарчук П. А., Ломакина Е. Ю., Белоусова Е. А. Опыт применения устекинумаба у пациентов с болезнью Крона с внекишечными проявлениями (псориаз). Медицинский совет. 2020;(15):121-126. doi: 10.21518/2079-701X-2020-15-121-126.

9. Shapina M. V., Belous S. S. Ustekinumab in Crohn’s disease with perianal manifestations and psoriasis-like skin changes induced by anti-TNF therapy. Effektivnaya farmakoterapiya. 2020; (15): 54-59. (In Russ.) doi: 10.33978/2307-3586-2020-16-15-54-59.@@ Шапина М. В., Белоус С. С. Устекинумаб при болезни Крона с перианальными проявлениями и псориазоподобными изменениями кожи, индуцированными анти-ФНО-терапией. Эффективная фармакотерапия. 2020; (15): 54-59. doi: 10.33978/2307-3586-2020-16-15-54-59.

10. Guillo L., D’Amico F., Danese S., Peyrin-Biroulet L. Ustekinumab for Extra-intestinal Manifestations of Inflammatory Bowel Disease: A Systematic Literature Review. J Crohns Colitis. 2021 Jul 5;15(7):1236-1243. doi: 10.1093/ecco-jcc/jjaa260.

11. Рugliese D., Daperno M., Fiorino G., Savarino E., Mosso E., Biancone L. et al. Real-life effectiveness of ustekinumab in inflammatory bowel disease patients with concomitant psoriasis or psoriatic arthritis: An IG-IBD study. Dig Liver Dis. 2019;51(7):972-977. doi: 10.1016/j.dld.2019.03.007.

12. de Risi-Pugliese T., Seksik P., Bouaziz J. D., Chasset F., Moguelet P., Gornet J. M., Bourrier A., Amiot A., Beaugerie L., Francès C., Guégan S; Ustekinumab-Crohn’s Disease-Neutrophilic Dermatosis Study Group. Ustekinumab treatment for neutrophilic dermatoses associated with Crohn’s disease: A multicenter retrospective study. J Am Acad Dermatol. 2019 Mar;80(3):781-784. doi: 10.1016/j.jaad.2018.06.065.

13. Fahmy M., Ramamoorthy S., Hata T., Sandborn W. J. Ustekinumab for peristomal pyoderma gangrenosum. Am J Gastroenterol. 2012 May;107(5):794-5. doi: 10.1038/ajg.2012.42.

14. Nunes G., Patita M., Fernandes V. Refractory Pyoderma Gangrenosum in a Patient With Crohn’s Disease: Complete Response to Ustekinumab. J Crohns Colitis. 2019 May 27;13(6):812-813. doi: 10.1093/ecco-jcc/jjy200.

15. Phillips F.M., Verstockt B., Sebastian S., et al. Inflammatory Cutaneous Lesions in Inflammatory Bowel Disease Treated With Vedolizumab or Ustekinumab: An ECCO CONFER Multicentre Case Series. J Crohns Colitis. 2020 Oct 5;14(10):1488-1493. doi: 10.1093/ecco-jcc/jjaa078.

16. Guenova E., Teske A., Fehrenbacher B., et al.Interleukin 23 expression in pyoderma gangrenosum and targeted therapy with ustekinumab. Arch Dermatol. 2011 Oct;147(10):1203-5. doi: 10.1001/archdermatol.2011.168.

17. Tarasova L. V., Busalaeva E. I. Сrohn’s disease with skin lesions in the form of gangrenous pyoderma (clinical case). Lechaschi Vrach. 2022;(7-8):57-61. (In Russ.) doi: 10.51793/OS.2022.25.8.009.@@ Тарасова Л. В. Бусалаева Е. И. Болезнь Крона с поражением кожи в виде гангренозной пиодермии (клинический случай). Лечащий врач. 2022;(7-8):57-61. doi:10.51793/OS.2022.25.8.009.