Behcet's Disease: Mouth and Genital Ulcers, Eye Inflammation, Treated by an Institute of Dermatology Lecturer

Behcet's Disease (pronounced beh-CHETS) is a rare systemic vasculitis. Its hallmark is frequently recurring mouth ulcers, together with genital ulcers, eye inflammation and skin rashes. It is common in the Middle East along the Silk Road. It is not contagious, but it needs long-term care shared among several specialties. In this article, a dermatology specialist explains the symptoms, diagnostic criteria and treatment options.

Symptoms of Behcet's Disease

• Mouth ulcers: Painful mouth ulcers that come back often. They are the presenting symptom in almost every patient.

• Genital ulcers: Ulcers on the genitals that often leave scars.

• Eye symptoms: Eye inflammation (uveitis) or inflammation of the retinal blood vessels, which can blur vision and needs urgent treatment.

• Skin symptoms: Skin rashes such as erythema nodosum, pustules and acne-like lesions (papulopustular).

Diagnostic Criteria (ISG 1990)

There is no single laboratory test that confirms Behcet's Disease. It is diagnosed clinically by a specialist using the ISG 1990 criteria: recurrent mouth ulcers at least 3 times a year, plus 2 of the following 4 findings.

• Criterion 1: Recurrent genital ulcers.

• Criterion 2: Eye inflammation (uveitis) or retinal vasculitis.

• Criterion 3: Skin lesions such as erythema nodosum, pseudofolliculitis or acne-like lesions.

• Criterion 4: A positive pathergy test, meaning a red bump or pustule appears within 48 hours after the skin is pricked with a needle.

Treatment Approach

Treatment depends on which organs are affected, and becomes more intensive as more systems are involved.

• Mucocutaneous disease only: Colchicine 1-2 mg/day, with or without topical corticosteroids.

• Resistant cases: Apremilast 30 mg twice daily (FDA-approved in 2019 for mouth ulcers).

• Major organ involvement (eyes, brain, blood vessels): Azathioprine 2-3 mg/kg/day, Cyclosporine 3-5 mg/kg/day or Methotrexate.

• Severe cases: Adalimumab (a TNF inhibitor) is the first-choice option for severe eye inflammation.

Shared care: Patients with eye symptoms need long-term eye examinations and shared care with an ophthalmologist and a rheumatologist.

Frequently Asked Questions

Is Behcet's Disease contagious? No. It results from immune-mediated inflammation of the blood vessels, not from an infection, and it does not spread from person to person.

Is there a blood test that confirms it? No single test confirms it. It is diagnosed by a specialist using the ISG 1990 clinical criteria.

Are frequent mouth ulcers always Behcet's Disease? Not always. Mouth ulcers have many causes, but if they recur often together with genital ulcers or eye symptoms, see a doctor for evaluation.

Can it be cured? It is a chronic disease that can be controlled with medication and ongoing follow-up. Although it is not easy to treat, appropriate care helps reduce complications.

If you have frequently recurring mouth ulcers together with genital ulcers, blurred vision or skin rashes, do not ignore them. Consult a dermatology specialist at Siam Dermatology, call +66 61 448 7000 or LINE @siamderm.

Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed July 16, 2026