Breaking Down Silos: Integrating GI and Dermatology for Inflammatory Disease Care

As immune-mediated inflammatory diseases continue to blur traditional specialty lines, the intersection between dermatology and gastroenterology has emerged as a critical—and often underexplored—area of clinical overlap. With growing recognition of shared pathophysiology between chronic skin and gut disorders, from psoriasis and hidradenitis suppurativa to Crohn’s disease and ulcerative colitis, the need for interdisciplinary collaboration has never been greater.

In the latest HCPLive Special Report, Raj Chovatiya, MD, PhD, a clinical associate professor of medicine at Rosalind Franklin University Chicago Medical School and as founder and director of the Center for Medical Dermatology and Immunology Research in Chicago, and Adelina Hung, MD, a clinical assistant professor at Rosalind Franklin University Chicago Medical School and director of the IBD program at Sinai Health System Chicago, explore the growing clinical and research intersections between dermatology and gastroenterology. Framed by their shared academic background and personal relationship as husband and wife, the conversation offers a detailed, cross-disciplinary look at how immune-mediated diseases of the skin and gut overlap—and how a collaborative care model can enhance outcomes for patients.

The discussion opens with a foundational look at shared pathophysiology. Hung outlines how skin and gut disorders—particularly inflammatory bowel disease (IBD) and chronic inflammatory dermatoses—frequently arise from a common cascade: genetic susceptibility, environmental triggers, barrier dysfunction, and inappropriate immune activation. The biologic parallel between the organs sets the stage for bidirectional comorbidities that she says are now well-documented in systematic reviews and meta-analyses. Patients with IBD, for instance, exhibit higher rates of psoriasis, hidradenitis suppurativa, and atopic dermatitis—and the reverse also appears true.

Chovatiya emphasizes that these overlaps are not just academic but clinically actionable, with dermatologic findings potentially offering visible early clues to underlying GI pathology. Hung notes that dermatologists often see patients before GI symptoms emerge—presenting a critical opportunity for early diagnosis and intervention, particularly in IBD, where prompt initiation of therapy can significantly alter disease trajectory and prevent complications like strictures, fistulas, and colorectal cancer.

Both speakers advocate for proactive, interdisciplinary care to bridge the diagnostic and therapeutic divide. Hung describes how improved communication between specialties could help avoid delayed referrals and disjointed treatment planning. Chovatiya adds that derm and GI often work in parallel without knowing what the other is prescribing, potentially risking polypharmacy, drug interactions, or suboptimal treatment choices.

The conversation then moves into treatment strategy, where both clinicians underscore the therapeutic convergence enabled by modern biologics. Hung highlights how recent years have ushered in an era of expanded treatment options for IBD—including anti-TNFs, integrin blockers, IL-12/23 inhibitors, and JAK inhibitors—which allow for more personalized care. With this expanding toolbox comes a responsibility to coordinate treatment across specialties to manage multimorbidity effectively.

They also discuss the broader barriers to interdisciplinary collaboration. Hung notes that communication between derm and GI is rare in day-to-day clinical practice, especially in systems without integrated specialty care or access to dermatologists. Dermatology referrals can be delayed by months, and cross-consultation is often informal or nonexistent. Chovatiya agrees, pointing out that dermatologists may hesitate to act on signs of GI pathology due to limited training or discomfort initiating care outside their domain. Ultimately, both experts call for increased cross-specialty education at the residency and fellowship level to build clinical confidence and shared language.

Research is another area ripe for cross-disciplinary advancement, with Chovatiya and Hung highlighting the need for clinical trials that enroll patients with multimorbidity and evaluate composite outcomes across organ systems. They advocate for studies that track dual inflammatory biomarkers, patient-reported outcomes, and treatment durability in both derm and GI contexts. Hung points to the emerging role of the microbiome as another shared frontier: while still exploratory, therapies like fecal microbiota transplant and targeted probiotics are already making inroads in GI care and may hold relevance for dermatology in the future.

The conversation closes with a focus on equity and health disparities. Hung emphasizes that patients from underserved communities—such as those seen in urban safety-net systems like hers in Chicago—often experience more complex disease and delayed access to care. For these populations, fragmented specialty care is particularly harmful. Coordinated communication and shared treatment planning are not just best practices—they’re essential to delivering equitable care. Chovatiya adds that addressing disparities will require guidelines that reflect real-world complexity and protocols that enable unified care plans, especially as many newer therapies gain approvals across multiple specialties.

Ultimately, the conversation is a call to action: to reframe siloed care models and instead embrace collaboration as essential to delivering equitable, efficient, and comprehensive care for patients with chronic inflammatory disease.

Editors’ note: Chovatiya has reported serving as an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, Apogee Therapeutics, Arcutis, Argenx, ASLAN Pharmaceuticals, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant, Eli Lilly and Company, FIDE, Formation Bio, Galderma, Genentech, GSK, Incyte, LEO Pharma, L’Oréal, Nektar Therapeutics, Novartis, Opsidio, Pfizer Inc, Regeneron, RAPT, Sanofi, Sitryx, and UCB. Hung has no relevant disclosures.