If you have ulcerative colitis (UC), the same inflammation that triggers flares in your intestines can have an impact on other parts of the body — including your skin.
Up to 35 percent of people with ulcerative colitis experience skin issues. In many cases, skin problems appear when you’re having a flare and improve when your inflammation subsides.
Here’s what to know about how ulcerative colitis leads to skin problems, 12 skin disorders that are associated with the condition, and how to manage symptoms.
5 Complications of Ulcerative Colitis
Ulcerative colitis is an autoimmune disease and a form of IBD. Complications from UC affect more than just the digestive track. Here are some things to watch out for.
Next up video playing in 10 seconds
Why Does Ulcerative Colitis Cause Skin Problems?
Ulcerative colitis–related skin conditions usually occur for one of the following four reasons, says Parambir Singh Dulai, MD, a gastroenterologist at Northwestern Medicine Digestive Health Center in Chicago.
The gut is unable to properly absorb certain nutrients, such as zinc or selenium, causing a deficiency.
Ulcerative colitis–related inflammation manifests in other body parts.
Co-occurring autoimmune conditions, such as psoriasis, cause skin symptoms.
Medications used to treat IBD or coexisting conditions produce side effects, such as acne.
Niket Sonpal, MD, a gastroenterologist and a professor at Touro College of Osteopathic Medicine in New York City, says the first line of defense against skin problems is to get a handle on your ulcerative colitis.
"If a patient of mine is having extraintestinal features of IBD, this, in turn, reflects that the underlying IBD is not in control," he says. "Manifestation of inflammation on the outside is a marker of more inflammation on the inside."
If you do notice any skin changes, it's important to tell your doctor right away so you can be seen by a dermatologist. Your treatment will depend on the type of skin problem you have.
Skin Disorders Associated With Ulcerative Colitis
The following are 12 skin conditions that may affect people with ulcerative colitis.
1. Erythema Nodosum
The most common skin condition associated with ulcerative colitis, erythema nodosum is a rash consisting of painful, raised bumps that usually appear on the legs.
"Erythema nodosum is a form of panniculitis, or inflammation of the subcutaneous fat in your skin," says Susan Massick, MD, a dermatologist at the Ohio State University Wexner Medical Center in Columbus, Ohio. "It can be associated with IBD flares or signal an impending flare."
You may also run a fever, have joint pain, and generally feel ill.
Treatment usually focuses on treating the underlying IBD. Erythema nodosum can resolve on its own with time, Dr. Massick says. But interventions such as pain-relieving medications, steroids (either taken by mouth or injection), or potassium iodide solution may help alleviate discomfort and clear up the bumps. Massick also recommends elevating your legs and limiting physical activity to help lessen swelling and tenderness.
Symptoms of erythema nodosum usually go away within three to six weeks, but the residual bruises may last for months, and the rash may come back.
2. Pyoderma Gangrenosum
This severe and debilitating condition starts with one or more small pink or purple bumps or pustules that quickly progress to large ulcers, says Madeline DeWane, MD, a dermatologist at Massachusetts General Hospital in Boston. These usually appear on the legs but can occur in other places.
In addition to sores, the disorder can cause fever, joint pain, and general malaise. Unlike many other ulcerative colitis–related skin conditions, pyoderma gangrenosum can appear even when someone's IBD is well-controlled, Dr. DeWane notes.
Treatments may include medicines that target the skin, such as anti-inflammatory creams, steroid ointments, and steroids injected into the ulcers, as well as therapies with stronger effects, such as steroid pills and immune-suppressing medication.
3. Aphthous Stomatitis
Better known as canker sores, these are small mouth ulcers that usually form along the gum lines, on the inner lip, or along the sides or base of the tongue. They're usually white in the center with a red rim, Massick says. These usually coincide with disease flare-ups but can also stem from IBD-related nutrient deficiencies, she says.
"Treat the flare, and these canker sores will improve," she says. "For short-term pain relief, medicated mouthwashes can help soothe. Also, avoid any harsh triggers, like acidic or spicy foods."
4. Pyoderma Vegetans
This is a rare skin manifestation of ulcerative colitis, Massick says.
"These are rough, warty raised plaques in skin folds, such as in the groin and armpits, often associated with darkening of the skin," Massick says.
Pyostomatitis vegetans is the same condition, but it occurs in the mouth, DeWane says.
This skin disorder usually runs in a parallel track to the ulcerative colitis flare, DeWane says. Treatment typically involves treating the ulcerative colitis itself. In some cases, a doctor may recommend a topical steroid.
5. Sweet Syndrome
This is another rare skin complication that can be associated with ulcerative colitis. The problem occurs more frequently in women than men and mostly between ages 30 and 50.
"Sweet syndrome typically appears as painful, pink or purple bumps on the head, neck, torso, and arms," DeWane says. "It may be accompanied by fever, joint pain, or eye inflammation."
This condition may look like erythema nodosum. Your doctor should be able to tell the difference by performing an exam and running some tests on your skin.
Sweet syndrome usually responds quickly to oral steroids but can also be treated with other anti-inflammatory medications, DeWane says. Once your ulcerative colitis is under control, sweet syndrome is less likely to return.
6. Finger Clubbing
In this condition, the skin underneath your fingernails thickens, and the fingertips become rounded, fat, and purplish, Massick says. The fingernails may also slope downward.
Patients with ulcerative colitis who smoke or have chronic pulmonary disease are at the highest risk for finger clubbing.
The clubbing itself is not harmful, and there is no treatment for it. But it's still important for your medical team to be aware of any skin and nail changes and to address the underlying ulcerative colitis.
7. Hidradenitis Suppurativa
This is a chronic skin condition causing painful nodules and boils, usually in the skin folds of the armpits and groin area, DeWane says.
"Hidradenitis suppurativa can be debilitating and lead to severe scarring, so early diagnosis and treatment is very important," she says.
There are multiple treatment options depending on the disease's severity and what body parts are affected, including topical anti-inflammatory medications, steroid injections, antibiotics, immunosuppressant medications, and surgery, she says.
8. Psoriasis
Because IBD and psoriasis share similar autoimmune pathways, some people develop both conditions, Massick says.
On lighter skin tones, psoriasis manifests as pink patches and silvery scales, usually on the knees, elbows, scalp, and trunk, she says. On darker skin, psoriasis lesions may appear purple or grayish.
Another chronic autoimmune condition, vitiligo involves a loss of pigment in the skin, Massick says.
"It looks like depigmented patches that remain white in color or won't tan," she says.
Although not caused directly by ulcerative colitis, vitiligo can occur alongside it since both conditions involve immune dysfunction, says Hannah Kopelman, DO, a dermatologist at Kopelman Aesthetic Surgery with offices in New York City. Some research has also linked it to certain biologic IBD medications.
Usually, vitiligo is only a cosmetic issue and doesn't require treatment.
But ultraviolet light therapy or immunosuppressant medications may help change the pigment or slow disease progression.
10. Acne
Pimples and other lesions can form when hair follicles become clogged with oil or dead skin cells. Some people with ulcerative colitis struggle with acne due to inflammation, or as a side effect of steroids, Kopelman says.
She usually recommends gentle skin care, noncomedogenic products (which don't clog pores), and sometimes topical or oral medications to keep breakouts under control.
A rare condition related to intestinal bacterial overgrowth, bowel-associated dermatosis-arthritis syndrome (BADAS) can cause flu-like symptoms followed by red or purple skin lesions and joint pain, Massick says.
"The bacterial overgrowth can be because of the underlying IBD inflammation or because of intestinal surgeries adversely affecting gut function," she says.
Managing IBD can help alleviate BADAS, but oral antibiotics or other treatments, such as immunosuppressive drugs, are usually also necessary.
12. Hives
Some people with ulcerative colitis develop allergic reactions to IBD medications, which can cause itchy, raised red bumps or hives, says Qin Rao, MD, a physician at Manhattan Gastroenterology in New York City.
If you get hives after starting a new IBD treatment, talk to your doctor about switching medications. They may also recommend antihistamines and topical steroids, Dr. Rao says.
Coping With Ulcerative Colitis Skin Problems
Rao says there's nothing you can do to completely prevent skin conditions related to ulcerative colitis. But since many of these problems coincide with flares, good UC management can go a long way toward keeping your skin healthy. Your gastroenterologist may recommend a combination of medications, including biologics, immunosuppressives, or corticosteroids, Dr. Sonpal says.
It's also important to work closely with a dermatologist, Rao notes.
"A patient should have a good dermatologist who they see regularly and feel comfortable speaking to when they see a rash they don't recognize," Rao says.
Your dermatologist may recommend additional treatments, such as light therapy or retinoids, depending on the specific skin issue.
"Reducing stress may also be helpful, as stress can contribute to both UC flares and worsening of inflammatory skin conditions," DeWane says.
To minimize the outward appearance of skin problems, try covering up problem areas with clothes if you can. Makeup is another option in some cases.
"In general, if the skin barrier isn't broken (meaning no open wounds or sores), it's safe to use makeup to cover up problem areas," DeWane says. "Fragrance-free products for sensitive skin are usually best to avoid irritation." Ask your healthcare provider which products are safe for you to use.
The Takeaway
Skin problems are relatively common in people with ulcerative colitis.
You may not be able to prevent these problems entirely, but managing your UC can reduce their likelihood and severity.
A gastroenterologist and dermatologist can help you keep these issues under control using treatments such as prescription and over-the-counter medications or light therapy, depending on your condition.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
Lambert JL et al. Cutaneous Manifestations in Biological-Treated Inflammatory Bowel Disease Patients: A Narrative Review. Journal of Clinical Medicine. March 3, 2021.
Gordon H et al. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. Journal of Crohn’s and Colitis. January 2024.
Li C et al. Oral manifestations serve as potential signs of ulcerative colitis: A review. Frontiers in Immunology. September 29, 2022.
Chrcanovic BR et al. Pyodermatitis-pyostomatitis vegetans: a case report and systematic review focusing on oral involvement. Oral and Maxillofacial Surgery. September 1, 2024.
Santos MI et al. Sweet's Syndrome: A Case Report of a Rare Extraintestinal Manifestation of Ulcerative Colitis. Cureus. March 8, 2022.
Antonelli E et al. Dermatological Manifestations in Inflammatory Bowel Diseases. Journal of Clinical Medicine. January 2021.
Mettananda C et al. Sequential occurrence of recurrent Sweet syndrome and erythema nodosum without an underlying secondary cause: a case report. Journal of Medical Case Reports. February 25, 2022.
Romeo S et al. Finger Clubbing in Inflammatory Bowel Disease: Association With Upper Small Bowel Lesions and Need of Surgery in Crohn’s Disease. European Journal of Gastroenterology and Hepatology. June 2021.
Stoenică I et al. Hidradenitis Suppurativa in Association with Ulcerative Proctitis: Surgical Management in a Refractory Case to Topical and Systemic Treatment. Reports. March 2024.
Joulfayan H et al. Anti-TNF-α therapy induced psoriasis in rheumatoid arthritis patients according to FDA postmarketing surveillance data. Scientific Reports. June 27, 2023.
Omrani F et al. P1159 New Onset Acne Reported in the Majority of Patients with Upadacitinib-Treated Inflammatory Bowel Disease. Journal of Crohn’s and Colitis. January 22, 2025.
Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.
Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.
She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.
Regina Boyle Wheeler is an Atlanta-based journalist who specializes in health, parenting, and lifestyle content. Her work has been featured on several websites including WebMD, CNN, MedicineNet, Huffington Post, U.S. News & World Report, and HealthDay.
Boyle Wheeler was a writer and producer at CNN and CNN Headline News for 15 years. She produced live news programming and worked on countless breaking news events. These included the uprising at Tienanmen Square, China, the fall of the Berlin Wall, the OJ Simpson trial, and the impeachment of President Bill Clinton. She was part of the award-winning team that covered the terrorist attacks on Sept. 11, 2001.
She is a proud graduate of Indiana University where she earned a bachelor's degree in broadcast journalism and political science. Balancing work and a growing family is challenging, but she relieves stress by reading, listening to music, and doing yoga.
Kate Daniel is a journalist specializing in health and wellness. Previously, she was a reporter for Whidbey News Group in Washington, where she earned four regional awards for her work. Daniel has written for various outlets, including HealthDay, Nice News, and Giddy.
