Metastatic Crohn's disease (MCD) is the rarest and one of the most disfiguring cutaneous manifestations of inflammatory bowel disease (IBD): non-caseating granulomatous inflammation at skin or mucosal sites not contiguous with the gut. Only about 500 cases have been reported since 1965, placing patients at the crossroads of gastroenterology, dermatology, and rheumatology. Because its course can run independently of bowel activity and may precede the underlying disease, MCD belongs in the differential of any chronic, treatment-resistant rash. A rare disease like this cannot be solved within a single specialty: this editorial introduces an interdisciplinary ECCO CONFER (Round 12) project that unites dermatologists and gastroenterologists across centres worldwide to assemble the largest MCD case series and validate the 2025 Delphi diagnostic criteria for these patients.