Other vitamin deficiencies are much less common today, because of the greater attention paid to nutrition and the use of intravenous feeding in severe illness. However, deficiencies of vitamins B, C, D, folate, essential fatty acids, calcium, and iron have all been reported. These deficiencies can appear as swollen or bleeding gums and a dry, flaky skin rash similar to zinc deficiency. Clinicians believe that this is caused by the sulfa-containing part of the compound. Newer drugs in this class, which contain the active component of sulfasalazine but eliminate the sulfa component, rarely cause skin problems.
Steroids can cause or worsen acne on both the face and back.
Prolonged use of these drugs may cause thinning of the skin as well as stretch marks, or stria, around the shoulders, hips, and lower abdomen. Puffiness around the face, swelling around the ankles, and slow wound healing also may be seen when prolonged use of steroids is needed. Their cause is uncertain. Epidermolysis bullosa acquisita is a blistering disorder affecting the knees, elbows, hands, and feet. It generally occurs in persons who have had Crohn's disease for many years.