Skin conditions. Crohn’s disease can cause certain skin conditions, including erythema nodosum, which is characterized by tender red nodules on the legs and shins, and pyoderma gangrenosum, which are large painful ulcers. “These skin conditions are caused by the inflammatory process of Crohn’s disease, and the treatment for them is to treat the Crohn’s disease, sometimes along with topical therapy by a dermatologist,” Kaur says. Another possible skin condition is psoriasis. Although psoriasis appears to be a skin disease because of its red patches covered with silvery scales, it’s actually an inflammatory disease. It’s also linked to arthritis and Crohn’s disease by way of psoriatic arthritis, an inflammatory joint disease that can cause bone and joint damage.
“Some of the medications used to treat Crohn’s disease increase the risk of non-melanomatous skin cancers and melanomas,” Fayek says. For instance, azathioprine and mercaptopurine may increase the risk for basal and squamous cell carcinomas of the skin, she adds, and biologic agents such as the anti-TNF class of drugs may increase the risk for melanomas. Always apply sunscreen, minimize excessive sun exposure, and get yearly skin checks by a dermatologist when on these medications, Fayek says.
“People with Crohn’s disease can become anemic and experience fatigue because of blood loss and inflammation,” Fayek says. “Fatigue can also be associated with depression, which is common in people with chronic conditions such as Crohn’s disease.”
Vitamin D deficiency can also contribute to fatigue, as can the body-wide inflammation that may go along with Crohn’s disease. “Taking vitamin D and iron supplements and effectively treating Crohn’s disease can all help to ease fatigue,” Kaur says.
Canker sores. While mouth sores aren’t a common symptom of Crohn’s disease, Crohn’s inflammation can involve any part of the GI tract, from the mouth to the rectum. “Severe oral involvement may present with aphthous ulcers [canker sores] or pain in the mouth and gums,” Fayek says. These painful mouth sores usually occur during Crohn’s flares and appear on the gums or the underside of the tongue. In addition to regular Crohn’s treatment, oral pain-relief rinses or gels, an oral antibiotic rinse, or corticosteroids may help.
Fever and infection. “Fever can be a symptom of Crohn’s disease because of the low-grade inflammation associated with the disease,” Fayek explains. “A fever is particularly concerning if someone is taking drugs for Crohn’s that suppress the immune system.”
Some people with severe Crohn’s disease can develop abdominal abscesses from the inflammation extending through the wall of the intestine to the abdominal cavity, Fayek explains. “Patients on immunosuppressive medications are particularly at risk for certain fungal infections and reactivation of tuberculosis,” she says. If you have a fever over 100.5 degrees Fahrenheit, she says, you should contact your gastroenterologist right away. If the source of the fever is an infection, you’ll likely be treated with antibiotics.
It’s important for people with Crohn’s who are on immunosuppressive therapy to be up to date on their vaccines, Fayek says. However, live, weakened virus vaccines should not be given to people on immunosuppressive therapy; they can and should receive the following inactivated vaccines:
- A yearly flu vaccine.
- Certain pneumonia vaccines. (Talk to your doctor about which ones should be offered to people starting immunosuppressive therapy.)
- DTaP (diphtheria, tetanus, and pertussis), which should be given as a booster, particularly if it’s been more than 10 years since your last vaccine.
Other inactivated vaccines include: the hepatitis A vaccine, Haemophilus influenzae type B (Hib), meningococcus, and HPV vaccine, Fayek says.
Your doctor can help you determine what kind of vaccination schedule you should follow.
Migraines. Some people with Crohn’s disease or ulcerative colitis can get migraine headaches, which are thought to be rooted in inflammation. Once people take medications for other symptoms of Crohn’s disease, their migraine headaches usually also improve, Kaur says.
Eye infections. “There are two types of eye conditions that can occur in people with Crohn’s disease, and both are emergencies,” Kaur says. The first is episcleritis, which is irritation and inflammation of the episclera, a thin layer of tissue that covers the white part of the eye. “Episcleritis is extremely painful, and it makes the eye very red,” she says. The second is uveitis, which is inflammation of the uvea, the middle layer of the eye. “Uveitis causes distinct pain,” Kaur says. Sudden redness, blurred vision, and light sensitivity are other possible symptoms, according to the American Academy of Ophthalmology. “Both eye conditions are rare, but if you have Crohn’s disease and experience any eye pain or redness, call your doctor or head to the emergency room right away.”
Like the digestive symptoms of Crohn’s disease, these non-digestive symptoms are more likely to crop up during a flare or if your Crohn’s is severe. If you have Crohn’s disease and experience any of these symptoms, talk to your doctor promptly to get the care you need.