Low-dose depot corticosteroids do not have a beneficial effect on the genital ulcers of Behçet's syndrome, but they may help control erythema nodosum lesions—especially in females, according to a new double-blind trial published in the March issue of Rheumatology.1

Characterized by recurrent oral and genital ulcerations, folliculitis, erythema nodosum, panuveitis, arthritis, thrombophlebitis, and gastrointestinal and central nervous system involvement, Behçet's syndrome is common in the Middle East, Asia, and Japan, but relatively rare in the US. Genital ulcers tend to occur in 80% of Behçet's patients and are difficult to treat topically due to their location. Corticosteroids are widely used in Behçet's syndrome, but there is a dearth of well-controlled studies showing safety and efficacy.

In the new study, 86 Behçet's syndrome patients who had active disease with genital ulcers received either intramuscular corticosteroid injections (40 mg methylprednisolone acetate) or placebo every 3 weeks for 27 weeks. Seventy-six patients (88%) completed the treatment. There were no significant differences in the mean number of genital and oral ulcers or folliculitis between groups at the study's end. The mean number of erythema nodosum lesions was less in the corticosteroid group as a whole, but a subgroup analysis showed that this finding was significant for female patients.

"In this, the first double-blind placebo-controlled study of depot corticosteroids in Behçet's syndrome, low-dose depot steroids were not effective in treating genital ulcers, or oral ulceration or folliculitis," conclude the researchers, led by Cem Mat, MD, a dermatologist at the Cerrahpasa Medical Faculty of the University of Istanbul in Turkey. However, the authors assert, "corticosteroids can be used in controlling erythema nodosum lesions, especially among females."

Behçet's treatment not universal

The new study "emphasizes that treatment with corticosteroids is not automatically indicated when a diagnosis of Behçet's syndrome has been made," says Colin G. Barnes, MD, honorary consulting rheumatologist at Royal London Hospital in London, UK. "This is the first report of a negative result of treatment," says Dr. Barnes, who also wrote an editorial accompanying the new report.2 "Treatment depends on the clinical assessment of the individual patient with regard to the principal manifestations of the condition and their severity in that patient," he says.

References

  1. Mat C, Yurdakul S, Ulysal S, et al. A double-blind trial of depot corticosteroids in Behçet's syndrome. Rheumatology. 2006;45:348-352.
  2. Barnes CG. Treatment of Behçet's syndrome. Rheumatology. 2006;45:245-247.