Low Rates of Dermatologic Care and Skin Cancer Screening Among Inflammatory Bowel Disease Patients
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Dermatologic manifestations of inflammatory bowel disease (IBD) are common, and certain IBD medications increase the risk of skin cancer.
To define the rates of care and factors associated with dermatologic utilization with a focus on skin cancer screening.
We utilized a prospective, natural history IBD research registry to evaluate all outpatient healthcare encounters from 2010 to 2016. Gastrointestinal, dermatologic and primary care visits per individual were identified. We calculated the proportion of patients obtaining care, categorized primary indications for dermatologic visits, determined the incidence of melanoma and non-melanoma skin cancers, and used logistic regression to determine factors associated with dermatology utilization.
Of the 2127 IBD patients included, 452 (21.3%) utilized dermatology over the study period, and 55 (2.6%) had a total body skin examination at least once. The 452 patients incurred 1633 dermatology clinic visits, 278 dermatologic procedures, and 1108 dermatology telephone encounters. The most frequent indication was contact dermatitis or dermatitis. Factors associated with dermatology use were family history of skin cancer, employment, systemic steroids, longer disease duration, emergency room use, and the number of IBD-related clinic visits. Between 8.3 and 11% of IBD patients recommended for skin cancer screening visited dermatology each year, and the resulting incidence of non-melanoma skin cancer was 35.4/10,000 [95% CI 23.3–51.5] and melanoma was 6.56/10,000 [95% CI 2.1–15.3].
Less than one in ten IBD patients obtain dermatologic care. Given the increased risk of skin cancers among IBD patients, an emphasis on education, prevention, and screening merits attention.
KeywordsInflammatory bowel disease Dermatology Dermatologic manifestations Skin cancer screening Preventative medicine
We would like to acknowledge the faculty, staff, and most importantly the generosity of our patients who continue to make this research feasible.
Alyce Anderson, BS contributed to drafting of manuscript, data organization, statistical analysis, table and figure creation, manuscript revisions, and critical review of the manuscript. Laura Ferris, MD, PhD contributed to data review, advisor to primary author, project supervision, and critical review of the manuscript. Benjamin Click, MD contributed to drafting of manuscript, data collection, and critical review of the manuscript. Claudia Ramos-Rivers, MD contributed to data collection and organization, and critical review of the manuscript. Ioannis E. Koutroubakis, MD, PhD was involved in critical review of the manuscript, collection of data. Jana G. Hashash, MD helped in critical review of the manuscript, collection of data. Michael Dunn, MD contributed to critical review of the manuscript and collection of data. Arthur Barrie, MD, PhD was involved in critical review of the manuscript and collection of data. Marc Schwartz, MD helped in critical review of the manuscript and collection of data. Miguel Regueiro, MD contributed to critical review of the manuscript and collection of data. David Binion, MD helped in critical review of the manuscript, collection of data, and project supervision and was advisor to primary author. All authors read and approved the final manuscript.
Alyce Anderson is supported by an NIH training Grant (TL1TR001858, PI: Kapoor). David G. Binion reports support from Grant W81XWH-11-2-0133 from the U.S. Army Medical Research and Materiel Command. Laura K. Ferris is supported by a National Cancer Institute Grant (5P50CA121973-08). Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number TL1TR001858. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Compliance with ethical standards
Conflict of interest
Alyce Anderson, Laura K. Ferris, Benjamin Click, Claudia Ramos-Rivers, Ioannis E. Koutroubakis, Jana G. Hashash, Michael Dunn, Arthur Barrie, Marc Schwartz, Miguel Regueiro, and David G. Binion declare they have no conflict of interest.
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