Kristen Brennan, DO; Daniel Stein, MD; Gretchen M. Roth, MD
WMJ. 2026;125(4):518-520. Published November 1, 2026.
ABSTRACT
Introduction: Extraintestinal manifestations of Crohn’s disease are associated with substantial morbidity and commonly present as arthropathies or painful lesions involving the skin, eyes, and mouth. However, they can involve nearly any organ system and do not correlate directly with intestinal inflammation, complicating diagnosis and treatment. As treatment options expand, this article explores the potential role of risankizumab in the treatment of cutaneous Crohn’s disease.
Case Presentation: A 75-year-old man developed a gluteal fissure consistent with cutaneous Crohn’s disease despite longstanding maintenance with adalimumab, an anti-tumor necrosis factor-α (TNF-α) monoclonal antibody. He transitioned to risankizumab, an interleukin-23 (IL-23) inhibitor, with resolution of cutaneous disease involving the gluteal cleft and continued luminal remission.
Discussion: This case report is the first to demonstrate successful treatment of anti-TNF-resistant cutaneous Crohn’s disease with an IL-23 inhibitor. No other published cases were found.
Conclusions: While TNF-α inhibitors remain the standard of care for extraintestinal manifestations of Crohn’s, IL-23 inhibitors are a promising therapy option.