The effects of biologic and/or immune suppressive therapies for treatment of chronic illnesses such as Inflammatory Bowel Disease (IBD) have been well documented and much discussed in the literature. While the side effect profile for biologic and/or immune suppressive treatment modalities is well known, the spectrum of dermatologic manifestations that can occur are varied and nuanced. Like many complex diseases, IBD requires a multi-disciplinary approach and for patients requiring aggressive treatment modalities such as biologic and immune suppressive therapies primary prevention counseling is a cornerstone of patient education and treatment adherence. The goal of the study was to highlight the clinical importance of counseling on dermatologic skin manifestations in the IBD patient population.Methods:
Over the course of a 6 month time period, the study utilized the electronic medical record system at a large academic center to perform a retrospective analysis on the rate of dermatologic related counseling for patients receiving treatment for IBD. Under the care of faculty gastroenterologists, the documentation of clinic visits were screened for discussion pertaining to primary prevention of skin manifestations while on biologic and/or immune suppressive therapies as well as dermatologic complications related to the treatment itself. The analysis controlled for age, gender, and race. Statistical analysis utilizing a 2-tailed Fisher's Exact Test with a P-value set less than 0.05 was used to interpret the results of our study.Results:
Of the 169 patients on biologic and/or immune suppressive therapy only 6 (4%) had a documented discussion concerning primary prevention and dermatologic complications. When compared to IBD patients not on biologic and/or immune suppressive therapies, of the 106 patients only 4 (4%) received counseling on the dermatologic manifestations associated with IBD. The statistical analysis of the study highlighted that there is no difference in counseling for IBD patients on aggressive treatment modalities compared to patients on less aggressive treatment options (P-value of 1.0).Conclusions:
The outlined study highlights a significant discrepancy in the stated guidelines for counseling patients on the use and effects of immune suppression and/or biologic treatment modalities. The lack of counseling on the importance of skin protection as well as side effects of certain medications limit patients' understanding of the pathophysiology of the disease as well as important monitoring of signs or symptoms of a negative reaction to such treatment options. Some of the rare but well documented skin manifestations associated with biologic therapies include: leucocytoclastic vasculitis, lichenoid drug reaction, perniosis-like eruption, superficial granuloma annulare and acute folliculitis. The importance of counseling cannot be more important now than ever before with the introduction of novel agents and therapies available for the treatment of Inflammatory Bowel Disease.