Breaking Barriers: How IBD and Skin Conditions Are Linked

People with inflammatory bowel disease (IBD) may also develop eczema and psoriasis because they’re triggered in similar ways.

Do you have IBD and dry, itchy, or flaky skin? You may also have an inflammatory skin condition such as eczema or psoriasis.

Eczema, or atopic dermatitis, causes patches of dry, itchy, inflamed skin, and it looks like a bumpy rash. It can appear anywhere on the body, but it’s commonly found in areas like the elbows, knees, hands, feet, and face.

Psoriasis causes inflamed, raised areas that have silvery scales. It can also be anywhere on the body, but it’s usually on the scalp, elbows, knees, and lower back.

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What’s the connection?

Both skin conditions are thought to be caused by a weakness in the skin barrier that causes an overactive immune response in the skin. These conditions are considered long-term and can flare up and seem worse at times. Sound familiar?

IBD is attributed to issues with the gut barrier and an overactive immune response. It has periods of flares and remission.

Essentially, a process similar to the one that attacks the gut can also affect the skin.

Approximately 1 in 4 people with IBD have another autoimmune condition, and they may be twice as likely to have one than people without IBD.

Psoriasis is an autoimmune condition. Eczema isn’t officially classified as an autoimmune disease, but it involves immune dysfunction and is closely linked with other autoimmune diseases, including IBD.

My son has Crohn’s disease and eczema. In recent years, his eczema worsened and became psoriasis. This might have been due to a paradoxical reaction, or an opposite reaction than expected, to his IBD medication.

Psoriasis can be a side effect of a biologic known as a TNF-alpha inhibitor, and this reaction tends to happen more often in children and adolescents.

Managing skin conditions with IBD

For a while, my son was able to manage his eczema and psoriasis with topical prescription medications. After they continued to worsen, we discussed the possibility of changing his IBD medications with his gastrointestinal (GI) doctor.

Several medications are now approved to treat both IBD and psoriasis. These medications can also help treat eczema. After considering the risks of starting a new medication, my son decided to switch to a different biologic medication and has seen improvement in his skin condition. His IBD has also remained under control.

I’ve accompanied my son to several dermatology visits in this process, and we’ve found ways to soothe his itchy, uncomfortable skin. Here are a few tips we’ve learned along the way.

Find a good dermatologist

The last thing you probably want to do is start seeing another specialist in addition to your GI doctor. It can be challenging to get an appointment as a new patient, too. However, it’s worth the effort because a good dermatologist can offer a variety of topical treatments.

You’ll likely need topical steroids to help with flare-ups and nonsteroidal options to help manage your condition. Talk with your GI doctor for dermatologist recommendations.

Moisturize regularly

Dry skin can make eczema and psoriasis itchier and more irritated.

In addition to using any topical treatments your dermatologist prescribes, apply a thick over-the-counter moisturizing cream to any affected areas at least once daily. Cetaphil and CeraVe are popular options. These lotions help seal in moisture to strengthen the skin’s barrier.

It’s also a good idea to avoid bathing too often because this can contribute to dry skin. Try to wash your sensitive skin every other day or every few days if possible.

Avoid irritants

Avoiding chemical irritants and allergens can help prevent eczema and psoriasis flares. It’s generally best to avoid products with fragrances and dyes, as those can trigger skin conditions.

Pay attention to skin reactions to personal care products, detergents, or allergens such as grass, pets, and dust. You’ll want to avoid contact with anything that causes your skin to flare.

If you’re having trouble determining what products affect your skin, your dermatologist can help rule out common irritants by doing a patch test. Through this test, my son discovered he was sensitive to lanolin, a common ingredient in skin care products.

Another way to determine if you’re sensitive to skin care products is to do a patch test at home.

Testing any new product before using it is a great way to prevent skin reactions.

Choose breathable fabrics

Opt for soft, breathable fabrics made from natural fibers like cotton, bamboo, silk, or merino wool. Natural fibers allow air to flow through the fabric, which helps your skin stay cool and comfortable.

Try to avoid synthetic fabrics like polyester and spandex and rough, scratchy fabrics. Synthetic fabrics can trap heat and sweat, which can irritate your skin.

Practice safe sun habits

For many people, sun exposure in moderation has benefits. Sunlight promotes vitamin D production, which is helpful for skin, bone, and immune system health.

Sunlight may improve eczema and psoriasis symptoms in some people, but this isn’t the case for everyone. Be sure to speak with your doctor if your symptoms worsen after being out in the sun.

Overdoing sunlight can cause sunburn, which damages already sensitive skin. The key is to use sunscreen — talk with your dermatologist about what level of SPF is right for you — and to avoid staying in direct sunlight for too long, especially when the sun is most intense, between 10 a.m. and 2 p.m.

Talk with your dermatologist about the benefits of sun exposure, how much time you can safely spend in the sun, and any precautions you need to take when outdoors.

The takeaway

Eczema and psoriasis are uncomfortable skin conditions that are common in people with IBD. By making some lifestyle changes and working with a dermatologist, you can manage these conditions.

Don’t forget to keep your GI doctor in the loop about any skin concerns. Like my son, you may benefit from an IBD medication that is approved to treat both IBD and inflammatory skin conditions.