Ulcerative Colitis Rash: Causes And How To Manage It

Medically reviewed by Dr. Kendall R. Roehl, MD, FACS
Written by Ramona Sinha

Anyone who has inflammatory bowel disease (IBD) knows how painful it can be. IBD is inflammation of the digestive tract, and medical professionals are not sure about the exact cause of this condition. Ulcerative colitis is a type of IBD that not only affects your digestive tract (the large intestine) but can also cause many skin issues (1). These skin issues can further aggravate your overall discomfort and pain. Let’s find out how ulcerative colitis can affect your skin.

Ulcerative Colitis And Skin Rashes: The Causes

Several kinds of rashes are associated with ulcerative colitis, an inflammatory condition that affects the large intestine. You may experience painful red rashes on the skin. These are triggered by the inflammation within your body and may appear as a medication side effect.

Ulcerative colitis is also associated with skin issues like psoriasis, vitiligo,  pyoderma gangrenosum, dermatosis, erythema nodosum (bruise-like painful rashes), and acquired epidermolysis bullosa (skin blisters). These issues often result from inflammation and problems associated with the immune system mechanism related to IBD. Immunodeficiency is a common concern for people with inflammatory bowel diseases like ulcerative colitis (1), (2).

Ulcerative colitis is also associated with Sweet’s syndrome (1). This rare inflammatory condition causes rashes on body parts like the arms, legs, trunk, face, and neck. Patients on immunosuppressive therapy may experience it when the therapy is intensified.

Knowing just the causes is not enough to treat the condition effectively. You also need to know the symptoms, as discussed below.

Signs And Symptoms Of Ulcerative Colitis

The intensity and seriousness of ulcerative colitis symptoms vary among the people affected by the condition. While some people may experience periods of mild symptoms, some might experience no symptoms at all.

However, the return of symptoms is quite common, and you may experience them during a flare-up. The common symptoms include (3):

  • Mild to severe abdominal pain
  • Diarrhea
  • Increase in abdominal sounds
  • Fever and rectal pain
  • Blood in stools
  • Sudden weight loss

Apart from these, ulcerative colitis may also cause:

  • Joint swelling and pain
  • Nausea
  • Reduced appetite
  • Ulcers and mouth sores
  • Eye inflammation

One of the other important aspects of handling skin issues associated with ulcerative colitis is to know the various skin conditions caused by it. These are discussed in the next section.

Skin Conditions Associated With Ulcerative Colitis

1. Erythema Nodosum

About 3% to 10% of the people with this ulcerative colitis may develop erythema nodosum in any body part. This is a condition in which you develop red and tender nodules on the skin.

The lesions may have a bruise-like appearance, and they can appear anywhere there is subcutaneous fat (the type of fat that sits right under the skin). The most common areas where you can develop erythema nodosum are the ankles, arms, shin area, knees, and trunk (1).

To ease the pain related to the condition, keep your legs elevated and apply a cool compress. In severe cases, pain relievers such as ibuprofen or naproxen may help.

2. Pyoderma Gangrenosum

This is the next most common skin condition that affects people with ulcerative colitis (1). A study conducted in 2011 involving 950 patients demonstrated that about 2% of them developed pyoderma gangrenosum (4).

This condition causes noninfectious nodules (blisters) on your skin. These eventually spread and develop into deep ulcers with wound edges. They can appear anywhere on your skin but mostly occur on the extensor surface of the legs (the side opposite to the joints), such as the shins and ankles. They may also appear on the extensor surfaces of your arms.

This condition is thought to be caused by abnormal functioning of your immune system. Usually, high doses of corticosteroids and other drugs are used to suppress your immune system to heal these wounds (1).

3. Hives

Hives are raised bump-like rashes on the skin that are itchy. These usually occur as a side effect of certain medicines you might be taking for ulcerative colitis. These can appear on any body part. If you feel that any medication is causing these reactions, consult your doctor immediately and ask for an alternative.

4. Fissures

IBD can also cause small tears or fissures in the skin around your anus. This can lead to blood in your stool and pain during bowel movement. While most of these tears heal on their own, warm baths and ointments can help ease the pain or itchiness.

If the fissure persists, doctors may prescribe various medicines to help relax the muscles in the affected area and promote fast healing (5).

5. Psoriasis

Psoriasis is a condition in which skin cells’ production speeds up, causing an excess buildup of cells on the skin surface. As a result, your skin looks scaly, with red patches all over the affected area. This is an autoimmune condition and can also be triggered by ulcerative colitis. A study found a prevalence of psoriasis in 5.7% of 88 patients with ulcerative colitis (6), (7).

6. Acne

Ulcerative colitis may also cause cystic acne. This is the most severe form of acne and can be painful. A study found that using isotretinoin for cystic acne might aggravate ulcerative colitis symptoms (8).

In other words, if you have ulcerative colitis or are at risk of developing this condition, and if you have cystic acne, taking this drug may worsen the symptoms of ulcerative colitis.

7. Vitiligo

This is a condition in which your skin loses its color. The cells (melanocytes) that produce melanin and are responsible for your skin color start dying or stop functioning. As a result, you get white patches on the affected area.

According to a study led by Richard Spritz, M.D., Director of the Human Medical Genetics Program, University of Colorado, the onset of vitiligo is “very highly associated” with other autoimmune diseases (9), (1).

8. Pyodermatitis-Pyostomatitis Vegetans

These are two different skin conditions – pyodermatitis vegetans and pyostomatitis vegetans.

Pyodermatitis vegetans is a very rare skin disorder in which you develop red pustules on the skin, which can easily rupture and form plaques or patches. It usually occurs in your skin folds, such as the groin or the armpits.

Similarly, in pyostomatitis vegetans, you get pustules in the mouth. The symptoms of both these conditions appear after you have had ulcerative colitis for a few years (1).

9. Sweet’s Syndrome

This is a very rare skin condition. You get painful skin lesions along with fever. The lesions look like red patches or clusters of red, painful bumps. These mostly appear on your head, neck, trunk, and arms. The exact cause of this skin disease is unknown. There are very rare cases (approximately 40) where researchers found a link between ulcerative colitis and Sweet’s syndrome (10), (11).

10. Bowel-Associated Dermatosis-Arthritis-Syndrome (BADAS)

This is a condition in which you develop lesions or pustules in areas such as the arms, upper chest, and legs. If you have Inflammatory Bowel Disease (either Crohn’s disease or ulcerative colitis), you are more likely to develop BADAS (12), (13).

11. Leukocytoclastic Vasculitis

In this condition, the small blood vessels under your skin become inflamed. As a result, they burst and create a pool of blood under your skin. This creates reddish-purple spots on your skin, also known as purpura. These are usually found on your legs and ankles. Typically, these spots go away once your ulcerative colitis symptoms are gone.

These skin rashes are usually caused due to inflammation within your body. However, some skin issues are caused as a side effect of the medicines you are taking for ulcerative colitis.

But is there any way to manage these issues?

Managing And Treating Skin Problems Caused By Ulcerative Colitis:

All of the above skin issues are related to ulcerative colitis, so the best way to manage them is to treat the underlying condition. Most of the time, you get skin rashes only during ulcerative colitis flare-ups. It is best to keep the condition in control to avoid getting these associated skin issues.

Ulcerative colitis-related issues are diagnosed with a combination of X-rays, blood tests, and stool tests. Alternatively, various medical imaging tests, such as MRIs, CT scans, and MRIs, are conducted for diagnosis.

Usually, doctors prescribe corticosteroids to manage skin inflammation. During a flare-up, you can take these measures to avoid skin issues:

  • Take the prescribed corticosteroid to reduce the inflammation.
  • Keep your skin or the affected area clean to reduce the chances of infection.
  • Follow a well-balanced diet. Vitamins and nutrients are essential for your skin health.
  • Keep open wounds, lesions, or patches (due to the skin disorder) covered with bandages.
  • Use a doctor-prescribed topical ointment or pain medication to manage discomfort.

Skin rashes and other complications associated with ulcerative colitis improve once the underlying causes are treated. Doctors may prescribe topical or oral steroids, antibiotics, and immunosuppressant medicines, depending on your condition.

To be prepared to deal with ulcerative colitis skin rashes, it is important to know who is prone to develop the condition. Read on to know more.

Who Gets Ulcerative Colitis?

Anyone can develop ulcerative colitis. However, you are at a greater risk of developing the condition if:

  • You have a family history of IBD.
  • You consume a high-fat diet.
  • You take nonsteroidal anti-inflammatory drugs (NSAIDS).

The Final Word

Ulcerative colitis is an inflammatory bowel disease that often causes ulcers in the colon’s lining and can lead to symptoms, such as abdominal cramping, bloody diarrhea, fever, and fatigue. The condition is also associated with a variety of skin rashes and conditions. Consult a doctor for proper diagnosis and treatment to manage this condition and the associated symptoms.

Expert’s Answers For Readers’ Questions

Is ulcerative colitis a contagious disease?

No, it is not contagious.

Can ulcerative colitis be completely cured?

No. It cannot be cured. However, you can manage the flare-ups with proper medical treatment.

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Ramona is a journalist-turned-content writer. She holds a Master’s degree in English Literature and has been writing for the digital world for over five years. She specializes in writing for Skin Care. She has done a certificate course titled ‘Dermatology: Trip To The Skin’, offered by Novosibirsk State University. She believes that beauty begins with a good skin care regimen and is on a mission to eliminate all toxins from her routine. She helps and guides readers in selecting products and ingredients specific to their skin type/issue. When Ramona is not working, her books and passion for music, good food, and traveling keep her busy.
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