What is Behcet’s Disease?
Behcet’s (Behçet’s) disease is an auto-immune inflammatory disease affecting the blood vessels (link – Vasculitis). The typical presentation of this disease is ulcers affecting the mouth, genitals and uvea. Uvea is a pigmented layer of eye, below cornea.
Behcet’s disease is common in the Middle East, Japan and Asia; Turkey has the highest prevalence of Behcet’s disease with 420 cases per 100,000 population. No wonder, this disease condition was first observed by a Turkish physician Hulusi Behçet. Globally, males are more commonly affected than females. The symptoms can begin at any age, although they usually appear between 20 and 30 years of age.
The cause is still unknown; but it is known to be immune-mediated, whereby the immune system mistakenly attacks the blood vessels. It being a form of Vasculitis (inflamed blood vessels), there is a possibility of a genetic predisposition. Both genetic and environmental factors have a role to play in developing this disease.
The symptoms of Behcet’s disease are dependent on the body area affected. The presentation varies from patient to patient.
1. Recurrent and painful mouth sores: Raised, round and recurrent lesions, which become painful later, usually found on lips, tongue and inside the cheek. The presentation can be confused with canker sores; but in Behcet’s disease, the ulcers are numerous, more frequent, larger and more painful. However, it must be noted that every case of mouth ulcer is not likely to be a case of Behcet’s disease.
2. Genital sores: Painful ulcers on the scrotum or vulva. They are painful and can leave behind a scar.
3. Skin sores: Ulcers anywhere on skin which may resemble an acne
4. Inflammatory eye disease (Uveitis) causing pain, redness and blurring of vision in one or both eyes.
5. Joint pain, swelling, stiffness, especially affecting large joints of the lower extremities, ankles and wrists.
6. Behcet’s disease affecting the gastro-intestinal tract can give rise to recurrent abdominal pain, nausea, diarrhea with or without blood
7. CNS involvement most commonly occurs as a chronic meningoencephalitis, producing seizures, dizziness, headaches, confusion or memory loss.
8. Pericarditis is a frequent cardiac manifestation.
The diagnosis of Behcet’s disease can be difficult as the disease is rare, has a varied presentation and mimics many other diseases.
1. Clinical diagnosis can be done based on typical presentation of recurrent, simultaneous and multiple oral and genital ulcers and eye inflammation.
2. Pathergy test: It is a skin test suggested for diagnosing Behcet’s disease. The test consists of pricking the skin with a sterile needle. The test is called positive for Behcet’s disease if there is a development of a sterile, red nodule or pustule greater than 2mm in diameter at 24 or 48 hours after the test.
3. Skin biopsy may support the diagnosis
4. ESR, CRP may be elevated
5. Lumbar puncture, MRI brain, bowel tests can be considered
Conditions related or similar to Behcet’s disease:
1. Candidiasis (Thrush)
2. Oral and genital Lichen Planus
3. Aphthous stomatitis
The conventional treatment includes symptomatic relief and palliation.
1. Steroidal applications for oral and genital ulcers
2. Immuno-suppressants (Methotrexate, Cyclosporine, Azathioprine, Thalidomide)
3. Corticosteroid eye drops for Uveitis
4. NSAIDs, colchicine for Arthralgia
5. Anesthetics, pain killers for pain relief
Behcet’s disease, being an immune-mediated condition, requires immunity correction. Since some of the other conditions in the same category of immune diseases, affecting the mouth, genitals and uvea; respond well to homeopathy; we can assume that homeopathy may have good role to play in the treatment of Behcet’s disease.
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