Does having psoriasis increase my risk of developing inflammatory bowel disease (Crohn’s disease or ulcerative colitis)?

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Last updated: February 15, 2026 • View editorial policy

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Yes, Having Psoriasis Increases Your Risk of Developing IBD

If you have psoriasis, you face approximately 2.5-fold higher risk of developing Crohn's disease and 1.7-fold higher risk of developing ulcerative colitis compared to people without psoriasis. 1

Magnitude of Risk

The association between psoriasis and IBD is well-established and clinically significant:

  • Crohn's disease prevalence ratio: 2.49 in psoriasis patients versus controls 1
  • Ulcerative colitis prevalence ratio: 1.64-1.91 in psoriasis patients versus controls 1
  • The risk increases with psoriasis severity—patients with severe psoriasis and those with psoriatic arthritis (especially axial involvement) face even higher IBD incidence 1
  • A Korean nationwide cohort study confirmed adjusted hazard ratios of 2.85 for Crohn's disease and 1.96 for ulcerative colitis in severe psoriasis 2

The relationship is bidirectional: Mendelian randomization analysis demonstrates that psoriasis causally increases odds of Crohn's disease (OR 1.35), and conversely, Crohn's disease causally increases odds of psoriasis (OR 1.43), establishing true dual causality rather than mere association 3

Absolute Risk in Context

While relative risks are elevated, the absolute 10-year incidence remains modest:

  • Crohn's disease: 2-5 per 1,000 psoriasis patients over 10 years 2
  • Ulcerative colitis: 7-11 per 1,000 psoriasis patients over 10 years 2
  • Younger patients (<30 years) face particularly elevated risk (adjusted HR 3.35) 4

Red-Flag Symptoms Requiring Immediate Gastroenterology Referral

You should be screened for IBD symptoms before starting systemic psoriasis therapy and monitored throughout treatment. 1 The American Academy of Dermatology recommends informing all psoriasis patients about this association (Strength of Recommendation B). 5

Seek immediate evaluation if you develop:

  • Chronic diarrhea lasting ≥3 months 1
  • Nocturnal bowel movements that wake you from sleep 1
  • Rectal bleeding not explained by hemorrhoids 1
  • Persistent abdominal pain 1
  • Perianal fistula or abscess 1
  • Unintentional weight loss 1

Critical Treatment Implications

If you develop IBD, certain psoriasis medications must be strictly avoided:

  • IL-17 inhibitors (secukinumab, brodalumab, ixekizumab) are contraindicated in patients with IBD because they can trigger or worsen Crohn's disease (AAD-NPF Strength of Recommendation C, Level of Evidence I) 5, 1
  • Clinical trials have demonstrated that IL-17 blockade appears ineffective for IBD and may cause disease flares 5

Preferred medications when both conditions coexist:

  • TNF inhibitors (adalimumab, infliximab) are FDA-approved and effective for both psoriasis and IBD 1
  • Ustekinumab (IL-12/23 inhibitor) is FDA-approved for both Crohn's disease and psoriasis, with demonstrated effectiveness in phase 3 IBD trials 1

Common Pitfall to Avoid

Do not dismiss gastrointestinal symptoms as irritable bowel syndrome (IBS). While psoriasis patients have a 24% higher hazard of IBS 1, the IBD risk is substantially greater (150-250% increase for Crohn's disease) 1. Misclassifying IBD as IBS delays critical treatment—any persistent GI symptoms warrant gastroenterology evaluation per AAD-NPF guidelines (Strength of Recommendation A). 5

References

1
Guideline

Treatment of Ulcerative Colitis and Psoriasis

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

5
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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