What are the symptoms of Behcet's disease?

In real life, many people are not familiar with Behcet's disease, and perhaps few people can discover it in the early stages. Behcet's disease needs to be treated in a timely manner. Hygiene should be maintained in daily life and a regular diet should be maintained. Behcet's disease can cause ulcers or acne on the skin or mouth.

1. Symptoms

All body systems are affected, the most common being the oral cavity, skin, genitals, and eyes. The central nervous system, blood vessels, and digestive tract are all more severely affected, with a higher incidence in males. Japanese scholars reported that the incidence rates of damage to various organ systems were: oral ulcers 100%, skin rashes 90%, external genital ulcers 97%, and eye damage 79%. Eye damage is more common in men than in women, with the incidence rates being 90% and 40% respectively. Other system damages included the central nervous system (28%), digestive system (20%), cardiovascular system (15%), and joints (15%). Huang Zhengji et al. analyzed the incidence of various clinical manifestations of Behcet's disease in my country: oral ulcers 99%, eye lesions 43.2%, external genital lesions 73.6%, skin lesions 96.8%, nervous system 26%, large blood vessels 8.7%, digestive tract 8.4%, and arthritis 60.9%.

A small number of patients have acute onset, with damage to two or more parts of the body occurring simultaneously within 5 days to 3 months. The condition is severe and is often accompanied by high fever. After a certain period of relief, the disease may recur chronically, with the average interval between two relapses being 1 to 2 months. Most of them are chronic diseases, with damage occurring first in one part of the body, and then after repeated attacks and relief at different times, the disease will occur in other parts of the body. The latter is mainly characterized by local damage and fewer systemic symptoms, but it may worsen acutely during the course of the disease.

Whether it is an acute attack or an acute exacerbation during a chronic disease, the main systemic symptoms are high fever, headache, fatigue, loss of appetite, joint pain or swelling, etc. The fever pattern is variable, and in a few cases, high fever may persist. Excessive fatigue, poor sleep, menstruation, seasonal climate changes, etc. can all aggravate damage to different parts of the body. A small number of patients have a family history, but no cases of contact transmission.

1. Basic symptoms

Refers to the most common and often the earliest symptom of this disease. They can occur one after the other or all at once over a period of several years. Most cases have an insidious onset, while a few have an acute onset accompanied by systemic symptoms such as fever and fatigue.

(1) Recurrent oral ulcers

The disease occurs at least three times a year. During an attack, more than one painful red nodule appears on the buccal mucosa, lip margin, lip, soft palate, etc., followed by ulceration. The diameter of the ulcer is generally 2 to 3 mm. Some cases begin with herpes, which disappears on its own after about 7 to 14 days without leaving any scars. Sometimes the disease persists for several weeks and eventually leaves scars. Ulcers come one after another. This symptom occurs in 98% of patients and is the first symptom of the disease. It is considered the most basic and necessary symptom for diagnosing this disease.

(2) Recurrent vulvar ulcers

The symptoms are basically similar to those of oral ulcers, but they occur less frequently and in smaller numbers. The most common sites are the labia majora and minora of female patients, followed by the vagina; and the scrotum and penis of male patients. It can also appear around the perineum or anus. About 80% have this symptom.

(3) Skin lesions:

Skin and mucous membrane damage is a major symptom of this disease, accounting for 95.7%. There are 4 types of skin lesions: It is the most common type of skin lesions, mainly in the lower limbs, especially the calves, and sometimes also occurs in the upper limbs and trunk, more common on the extensor side. Subcutaneous nodules are generally the size of a bean to a walnut, with varying depths and are painful and tender. The skin is light red, dark red or purple-red and has a hard texture. The numbers range from a few to dozens, scattered irregularly. It may disappear on its own in about 1 month, but it is easy to relapse. Or one side may disappear while a new one appears on the other side. Most of the cases are more severe in summer and rarely break out. The red range of some nodules may exceed the nodule area, and the color becomes lighter towards the outside, as if surrounded by a red halo.

It mainly occurs in the lower limbs and sometimes in the upper limbs. It is a hard subcutaneous cord when touched and has local tenderness. If it occurs deep under the skin, there will only be a feeling of subcutaneous cords during physical examination; if it occurs in the superficial subcutaneous veins, there may be varying degrees of redness on the skin surface and cord-like objects raised from the skin. Superficial thrombophlebitis may also occur secondary to intravenous drug administration.

It occurs more frequently in males than in females, and folliculitis-like lesions are more common than furunculoid lesions. This type of skin lesion can occur anywhere on the body surface, most commonly on the head, face, chest, back and genitals. The number of skin lesions varies and they may recur, with the disease being most severe in summer. These lesions have more obvious basal infiltration, fewer pustules on the top, larger surrounding redness, and are accompanied by varying degrees of nodules. Bacterial cultures were negative and antibiotic treatment was ineffective.

Injection (muscle, vein), acupuncture, etc. can injure the dermis of the skin. After 24 to 48 hours, red papules with pustules in the center will appear at the puncture site, which will gradually form a scab. This reaction is called acupuncture reaction. It disappears in about 1 week. It is usually positive during the active phase of the disease and has specific diagnostic significance. Sometimes the acupuncture reaction is negative. In this case, normal saline is injected and pustules will generally appear at the acupuncture site 24 hours later. It must be emphasized that even a negative acupuncture reaction cannot rule out Behçet's disease.