These manifestations occur commonly with joint, mouth, and skin findings. Many other eye manifestations can occur with IBD, but rarely include such serious problems such as optic neuritis, myositis with proptosis, papillopathy, chiasmal disease or orbital neuropathy. Erythema nodosum are painful nodules usually found on the anterior tibial surfaces that coexist with other eye, joint and oral findings during active disease, usually colonic Crohn s. Biopsy of these lesions is unnecessary and may lead to local necrosis and scarring, and histology does not add to information available from clinics examined. Other conditions that must be considered in erythema nodosum include Sarcoid, streptococcal disease, penicillin reactions, tuberculosis, and even leprosy.
Treatment can include steroids once the diagnosis can be fully established.
Pyoderma gangrenosum may present years before the IBD diagnosis is established. These necrotizing, centrally ulcerating skin lesions can persist years after proctocolectomy or resection of diseased bowel. Although favoring the lower extremities, it may occur anywhere including the face, scalp, or parastomal areas. This lesion has also been reported with multiple myeloma, carcinoma, cryofibrinogenemia, and occasionally following local trauma. Therapy is difficult and pyoderma may even prove refractory to steroids.