“It’s very common for bowel flares to be accompanied by extra-intestinal manifestations like skin rashes and mouth sores,” says Laura Raffals, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota. According to the Crohn’s & Colitis Foundation, up to 20 percent of people with inflammatory bowel disease also experience skin disorders. In many cases, these skin concerns appear when you’re having a flare and improve when your inflammation subsides. Your first line of defense against skin problems is to get your ulcerative colitis under control, says Matilda Hagan, MD, co-director of The Center for Inflammatory Bowel and Colorectal Diseases at Mercy Medical Center in Baltimore. If you do notice any skin changes, it’s important to tell your doctor right away so you can be seen by a dermatologist. Your treatment will depend on the type of skin problem you have. RELATED: 5 Complications of Ulcerative Colitis and How to Avoid Them

  1. Erythema Nodosum The most common skin condition associated with ulcerative colitis, erythema nodosum is a rash that consists of painful, raised bumps and is usually found on the legs. It tends to develop when ulcerative colitis is active, notes Dr. Hagan. You may also run a fever, have joint pain, and generally feel ill, according to Medline Plus. Treatment options include pain-relieving medication, steroids (taken either by mouth or injection), and a potassium iodide solution to clear up the bumps. “A cool compress can also help alleviate discomfort and reduce inflammation,” says Kally Papantoniou, MD, a dermatologist in private practice in Melville, New York. She also recommends elevating your legs to help lessen swelling and tenderness. Compression stockings can also be helpful, but have your doctor evaluate you for vascular disease before using them, cautions Dr. Papantoniou. Symptoms of erythema nodosum usually go away within three to six weeks, but the residual bruises may last for months. In about 20 percent of cases, the rash comes back.
  2. Pyoderma Gangrenosum This is a severe and debilitating condition that starts as a rash made of red or purple bumps or blisters, and then quickly spreads. These blisters eventually join together and form deep open sores (ulcers), according to the Crohn’s & Colitis Foundation. The ulcers are most often found on the shins or ankles but can occur almost anywhere. “People can have them on their feet, making it difficult to walk,” Hagan says. Sometimes the rash develops around the site of an injury or surgical wound. In addition to sores, the disorder can also cause fever and joint pain, as well as general malaise. Unlike many other ulcerative colitis–related skin conditions, pyoderma gangrenosum often appears when bowel disease is quiet, notes Hagan. Treatments may include medicines that target the skin, such as anti-inflammatory creams, steroid ointments, and steroids injected into the ulcers, as well as whole-body therapies, such as steroid pills and immune-suppressing medication.
  3. Aphthous Stomatitis Better known as canker sores, these are small mouth ulcers (typically white with a red base). They are most often found between the gums and lower lip or along the sides or base of the tongue. In people with ulcerative colitis, canker sores are often larger than a centimeter and hang around longer than two weeks, says Joaquin Brieva, MD, a dermatologist at Northwestern Memorial Hospital in Chicago. They are usually seen during severe flare-ups of ulcerative colitis and generally subside as the bowel disease is brought under control. Canker sores that are large, painful, or don’t heal before new ones appear may be treated with a prescription antibacterial mouth rinse, a corticosteroid ointment, or a prescription or nonprescription solution to reduce the pain and irritation, says Dr. Brieva.
  4. Pyoderma Vegetans This is a rare condition associated with inflammatory bowel disease that appears as blisters, plaques, or patches around the groin and under the arms. It tends to affect men more than women. Pyostomatitis vegetans is the same condition, but it occurs in the mouth, Brieva says. This skin disorder usually runs in a parallel track to the ulcerative colitis flare. Treatment typically involves treating the ulcerative colitis itself. In some cases, a topical steroid may be recommended.
  5. Sweet’s Syndrome This is another rare skin complication that can be associated with ulcerative colitis. The problem occurs more frequently in women than men, and mostly between ages 30 and 50, according to a review published in the January 2021 issue of the Journal of Clinical Medicine. Sweet’s syndrome typically comes with a sudden fever, along with a rash made up of many tender red or bluish-red bumps or spots. The bumps or spots usually develop on the arms, legs, torso, face, or neck. You may also get joint pain, fatigue, headaches, muscle pain, eye problems, or a general feeling of not being well. This condition may look like erythema nodosum. Your doctor should be able to tell the difference by performing an exam and running some tests on your skin. Sweet’s syndrome is usually treated with steroids. In some cases, however, it recurs after treatment. Treating your ulcerative colitis can reduce the chances that it will return.
  6. Finger Clubbing In this condition, the skin underneath your fingernails thickens and the fingertips become rounded and fat, like the tip of a drumstick, Brieva says. Your nails may also slope downward. Patients with ulcerative colitis who smoke or have chronic pulmonary disease are at highest risk for developing finger clubbing, according to a study published in June 2021 in the European Journal of Gastroenterology and Hepatology. The clubbing itself is not harmful, and there is no treatment for it. However, it’s still important for your medical team to be aware of any skin and nail changes and to address the underlying ulcerative colitis. RELATED: Thinking of Stopping Ulcerative Colitis Medication? Think Again

Coping With Ulcerative Colitis Skin Problems

There’s really nothing you can do to prevent any of the skin conditions related to ulcerative colitis, says Hagan. But since many of these problems coincide with flares, it can be helpful to manage the underlying ulcerative colitis as much as possible. It can also be helpful to reduce stress, which can trigger flares — and, in turn, skin problems, says Papantoniou. “Meditation or deep breathing may be very helpful in reducing stress,” she adds. To minimize the outward appearance of skin problems, try covering up problem areas with clothes if you can — and makeup is okay in some cases. “As long as the skin barrier isn’t broken, it’s safe to cover up hyperpigmentation or red patches with a concealer,” says Papantoniou. Ask your healthcare provider which products are safe for you to use. Additional reporting by Jordan M. Davidson.