Behçet's Disease: Symptoms, Diagnosis, and Specialist Referrals

Q: Behçet's Disease: Symptoms, Diagnosis, and Specialist Referrals

Hello, Miss Fei： Thank you for your questions. <br>Regarding the first issue of scalp itching, I recommend using a shampoo with lower degreasing ability and washing your hair every two days. <br>Due to the nature of your hair, applying lotion to the scalp can be challenging, so t

Regarding Behçet's disease?

Hello Doctor, I have the following symptoms and would like to inquire if they could possibly be related to Behçet's disease; if not, which specialty should I consult for improvement?
1.
I have seborrheic dermatitis on my scalp, which causes flaky skin that resembles scabs and is prone to itching, especially in the dry winter months (although I apply body lotion daily).
A dermatologist diagnosed it as winter eczema, but it also itches in the summer and was labeled as generalized eczema.
The itching mostly occurs before bedtime, but I'm not sure if that's coincidental.
2.
My left knee has unexplained swelling and pain; I can squat and walk, but there is mild pain, especially when going down stairs.
I previously experienced bilateral pain that made it difficult to squat or stand, but it resolved on its own after a few days (not during my menstrual period).
Additionally, when I was around fifteen or sixteen, I had unexplained lower back pain for about a year, which caused pain upon waking and made it difficult to get out of bed.
Using a chair with back support helped, but I still experience occasional pain.
3.
I have a long-term ulcer in the perineal area that hasn't healed.
I have not engaged in any invasive sexual activity and do not believe I have any injuries, but I do have increased secretions during ovulation.
I have experienced unexplained pain in my joints (lower back, knees, neck, and hips), and X-rays have shown normal results, with only slight scoliosis (5-10 degrees).
Despite not having sexual activity, the perineal fissures keep recurring, and I recently had severe oral ulcers, with new ones appearing before the old ones healed.
I often choke when drinking water.
I consulted a rheumatologist, and the results were normal.
Doctor, could it be that Behçet's disease was not detected during the examination because my symptoms were not severe at that time? Since it will take a while to schedule another appointment, by the time I go, the ulcer situation may have improved significantly (I was taking traditional Chinese medicine during that time, which includes anti-inflammatory ingredients like licorice).
Should I undergo another examination? Or, if the possibility of Behçet's disease is ruled out, which specialty do you recommend I consult to address these issues? Thank you.

Fei, 20~29 year old female. Ask Date: 2019/02/17

Dr. Xu Peiqi reply Family Medicine

Hello, Miss Fei: Thank you for your questions.
Regarding the first issue of scalp itching, I recommend using a shampoo with lower degreasing ability and washing your hair every two days.
Due to the nature of your hair, applying lotion to the scalp can be challenging, so the best approach is to reduce the frequency of washing or use a milder shampoo.
The same principle applies to your body skin; try to use a gentler body wash and avoid medicated soaps.
In winter, you can even use body wash every two days to maintain moisture, as there is no better oil than your own natural sebum.
For your second issue of polyarticular pain, based on your description, it seems to be related to previous back pain and recent knee pain.
These two pains do not appear to be connected and can resolve on their own, so there is no need to worry about autoimmune arthritis.
Typically, autoimmune arthritis would present with more severe and frequent symptoms.
What you need is to drink plenty of water (to hydrate your joints) and engage in more exercise (to increase muscle endurance and strength, thereby delaying joint degeneration).
Regarding your third issue of chronic ulcers in the perineal area, I recommend that you consult a gynecologist to identify the root cause and rule out the possibility of malignant changes.
As for recurrent oral ulcers, as long as the locations are not fixed and they heal within one to two weeks, there is no need for excessive concern.
However, you can consider supplementing with vitamins and maintaining good sleep to enhance oral immunity.
The symptoms you described are not significantly related to Behçet's disease unless new symptoms arise or existing symptoms worsen noticeably.
Therefore, there is no need to consider Behçet's disease at this time.
Wishing you a speedy recovery.

Reply Date: 2019/02/17

More Info

Behçet's Disease is a complex and multifaceted condition that can be quite concerning, especially when symptoms are present that may suggest its involvement. This disease is classified as a systemic vasculitis, meaning it involves inflammation of blood vessels, and it can affect multiple organ systems. The symptoms you described, including scalp issues, joint pain, and persistent ulcers, warrant a thorough evaluation.

1. Symptoms Overview:
- Scalp Issues: The seborrheic dermatitis you mentioned could be a separate condition, but it’s important to note that skin manifestations are common in Behçet's Disease. Behçet's can cause various skin lesions, including papules, pustules, and erythema nodosum. If your scalp condition is persistent and accompanied by other systemic symptoms, it may be worth investigating further.

- Joint Pain: The joint pain you’ve experienced, particularly the swelling and discomfort in your left knee, could be indicative of inflammatory arthritis, which can occur in Behçet's. The history of bilateral knee pain and back pain may also suggest a rheumatological issue.
- Genital Ulcers: The chronic ulcers in the genital area are particularly concerning, as they are one of the hallmark symptoms of Behçet's Disease. These ulcers can be painful and may recur frequently.

- Oral Ulcers: The recurrent oral ulcers you mentioned are another classic symptom of Behçet's. These can significantly impact quality of life and may be associated with systemic manifestations.

2. Diagnosis:
- Behçet's Disease is primarily diagnosed based on clinical criteria, as there are no definitive laboratory tests for it. The International Study Group for Behçet's Disease has established criteria that include recurrent oral ulcers, genital ulcers, eye lesions, and skin lesions. If you have had a thorough evaluation by a rheumatologist and they found no abnormalities, it is possible that your symptoms were not severe enough at the time of examination to meet the diagnostic criteria.

- It is also important to consider that symptoms can fluctuate; they may worsen or improve over time. If your ulcers and other symptoms have improved since your last visit, it may be challenging to capture the disease's activity during your next appointment.

3. Next Steps:
- Follow-Up: Given your symptoms, it would be prudent to follow up with a rheumatologist, especially if your symptoms recur or worsen. They may recommend further testing or imaging to evaluate joint involvement or other systemic issues.

- Specialist Referrals: If your rheumatologist has ruled out Behçet's Disease but your symptoms persist, consider consulting with a dermatologist for your skin issues and a gynecologist for the genital ulcers. A gastroenterologist may also be helpful if you experience gastrointestinal symptoms or complications.

- Monitoring: Keep a detailed record of your symptoms, including the frequency and duration of ulcers, joint pain episodes, and any other systemic symptoms. This information can be invaluable for your healthcare providers in making an accurate diagnosis.

4. Management:
- If Behçet's Disease is confirmed, treatment typically involves managing symptoms and controlling inflammation. This may include corticosteroids, immunosuppressive agents, or biologics, depending on the severity and manifestations of the disease.

- For symptomatic relief, topical treatments for ulcers, pain management strategies for joint pain, and appropriate skin care for dermatitis may be recommended.

In conclusion, while your symptoms could suggest Behçet's Disease, a definitive diagnosis requires a comprehensive evaluation by a specialist. It is essential to communicate openly with your healthcare providers about your concerns and symptoms, as this will help guide appropriate referrals and management strategies.

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