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Dermpath-India Skin lesion in Crohn's Disease (Non-Caseating Granulomatous Inflammation) Dr Sampurna Roy MD 2022
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Crohn's disease is a chronic inflammatory bowel disease which may have distinctive mucocutaneous manifestations. The classic pathology of skin disease discontinuous from the inflamed gastrointestinal tract in patients with Crohn's disease includes pyoderma gangrenosum, Sweet’s syndrome, hidradenitis suppurativa, erythema nodosum , and so-called metastatic Crohn's disease. All the lesions are characterized by neutrophils. Perianal lesion includes skin tags, fistulas and abscesses. Cheilitis granulomatosa may occur on the lips. (Melkersson Rosenthal Syndrome ) Cutaneous "metastatic Crohn's disease" is a granulomatous inflammation of the skin that is noncontiguous to the gastrointestinal tract. Age: Usually young adults. Sex: Both male and female with slight predominance of women. Clinically, the lesions present as vesiculopustules and painful erythematous nodules. Site: In metastatic Crohn's disease the lesions may occur on the following sites: (1) Intertriginous area (2) Limbs (3) Rarely vulva, scrotum and penis (Common in children). (4) Head and neck The lesions may ulcerate and later heal leaving a scar. Microscopic features: Non-caseating granulomas are present in the reticular dermis and subcutis. Granulomas may have a perivascular distribution. Lymphocytes may be present in the wall of medium-sized vessels situated at the junction of the dermis and the subcutaneous fat. Perivascular and sometimes periadnexal lymphocytic infiltrate may be noted. Other features: Presence of "Vesiculopustules" characterized by presence of neutrophils in large numbers in one or more infundibula, as well as in the upper part of the dermis. Patchy infiltrates of neutrophils may be present in lobules in the subcutaneous fat. There may be thromboembolic phenomena and features of cutaneous vasculitis.
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