Characteristics, management, and long-term outcomes of pyoderma gangrenosum and erythema nodosum in inflammatory bowel disease: Data from the ENEIDA registry
Iago Rodríguez-Lago, Milagros Vela, Ingrid Ordás, Ruth de Francisco, María Dolores Martín-Arranz, Margalida Calafat, Cristina Alba, Francisco Mesonero, Esteban Fuentes-Valenzuela, Alicia Granja, Ángel Ponferrada-Díaz, Pilar Varela, Yamile Zabana, Lucía Madero, Ignacio Marín, Marta Carrillo-Palau, Viviana Laredo, Eduard Brunet-Mas, Montserrat Rivero, Javier P. Gisbert, Cristina Polo, Cristina Rodríguez, Carles Suria, Rufo Lorente, Ainara Elorza, Beatriz Sicilia, María del Carmen Muñoz-Villafranca, Alejandro Mínguez, Rocío Ferreiro-Iglesias, Ramón Pajares Villaroya, Jesús Castro-Poceiro, Gerard Surís, Cristina Roig, Raquel Mena, Alfredo J. Lucendo, Luisa de la Peña, Eduardo Iyo, Yolanda Ber, Eva Iglesias-Flores, Coral Tejido, Daniel Ceballos, Eva Sesé, Teresa de Jesús Martínez Pérez, Alejandra Fernández, Pau Sendra, Alejandro Hernández-Camba, Elena Ricart, Eugeni Domènech, Manuel Barreiro-de AcostaBackground
Extraintestinal manifestations are common in inflammatory bowel disease (IBD), with erythema nodosum (EN) and pyoderma gangrenosum (PG) among the most frequent cutaneous manifestations.
Objectives
To characterize EN and PG in patients with IBD and describe their management, impact on IBD treatment, and long-term outcomes.
Design
Retrospective, multicentre study based on data from the prospectively maintained nationwide ENEIDA registry in Spain.
Methods
Patients with IBD and dermatologist-confirmed EN or PG diagnosed between January 2013 and February 2023 were included. Clinical characteristics, lesion distribution, treatments, response at week 8, impact on IBD management, and recurrence during follow-up were assessed.
Results
Overall, 528 patients were included (394 EN; 134 PG). EN occurred predominantly in women and patients with Crohn’s disease, whereas PG showed a less pronounced female predominance (60% vs 77%) and no clear association with IBD type. EN was more frequently diagnosed during clinically active IBD than PG (64% vs 48%; p=0.006). Lesions mainly involved the lower limbs (93% EN; 79% PG); EN was more often multiple and bilateral. Most lesions developed after IBD diagnosis, although 14% of EN and 8% of PG preceded it. At week 8, remission (complete resolution of nodules or ulcerated lesions) was achieved in 77% of patients with EN and 43% with PG. PG more frequently required advanced therapies than EN (39% vs 15%; p<0.001) and showed a longer time to lesion resolution. Anti-TNF agents were the most frequently used biologics, followed by ustekinumab. Cutaneous manifestations led to modification of IBD treatment in 18% of EN and 29% of PG cases. After a median follow-up of approximately 70 months, recurrence occurred in 21% and 22% of patients, respectively, and more than half of those with recurrence experienced multiple episodes.
Conclusion
In this retrospective cohort, EN and PG in IBD differed in their patient characteristics, association with IBD activity and treatment requirements. PG showed a slower short-term response and more often required advanced therapy, while both conditions had similar long-term recurrence rates. These findings suggest that multidisciplinary management and long-term follow-up may be beneficial, and they should be confirmed in prospective studies.