A role for B₁₂ in inflammatory bowel disease patients with suppurative dermatoses? An experience with high dose vitamin B₁₂ therapy.

BACKGROUND: Inflammatory dermatoses in conjunction with inflammatory bowel disease (IBD) comprise a diverse range of disorders. Some but not all of these respond to conventional treatments for the underlying IBD, such as immunomodulating or antibiotic treatments. We describe our experience with high dose vitamin B₁₂, where conventional therapies have failed. CASE REPORTS: The first case had pouchitis complicated by perianal abscesses and a recto-vaginal fistula. The second case had biopsy proven hidradenitis suppurativa affecting the perianal, inguinal and pubic skin. High dose vitamin B₁₂ appeared to be the major factor in preventing the recurrence of suppuration in both patients. Neither patient had vitamin B₁₂ deficiency. Open label experience: high dose vitamin B₁₂ treatment of a further 10 consecutive IBD patients with dermatoses was thought to provide benefit to six of them, but did not appear useful in four patients with perianal Crohn's disease with fistulae as the only manifestation of cutaneous disease.
CONCLUSIONS: There appears to be a subset of IBD patients with perianal and more distant inflammatory dermatoses, who benefit from high dose vitamin B₁₂ treatment. Clinical trials in IBD patients with biopsy-characterised suppurative dermatoses will be required in order to properly define the role of this safe and economical therapy.