Papulopustular Lesions Research Articles

Gender disparities in Behçet's syndrome: identifying distinct phenotypes through cluster analysis.

Behçet's syndrome (BS) is a complex, multi-systemic disorder with a global occurrence, notably concentrated along the Silk Road. This study aimed to investigate gender-specific expressions and clinical phenotypes in BS patients within the Eastern Black Sea Region of Turkey. A total of 290 BS patients were retrospectively analyzed between January 2013 and December 2023. Demographic characteristics, clinical manifestations, medical treatment, and pathergy test results were obtained from a review of medical records. The mean age was 45.79 ± 13.05, with a male-to-female ratio of 48.6:51.4. Male patients had higher papulopustular lesions (p < 0.001) and ocular involvement (p = 0.036), while females showed more frequent genital ulcers (p = 0.032). Medication usage showed gender-based variations, notably higher corticosteroid, azathioprine, and tumor necrosis factor-alpha inhibitor (TNFi) use in males (p < 0.001). Cluster analysis revealed five distinct clusters, each with unique features and gender predominance. Cardiovascular type, ocular type, and skin type predominantly featured male patients, while joint involvement type and neurologic and mucosal involvement type were more prevalent among female patients with BS. This research contributes valuable insights into the gender-related clinical variations of BS within a specific geographic region, fostering a more comprehensive understanding of this challenging syndrome. The identification of distinct clinical phenotypes facilitates the development of tailored treatment strategies, potentially leading to improved outcomes for patients with BS.

A case of multisystem Langerhans cell histiocytosis with risk organ (liver) and special site (craniofacial) involvement

Langerhans cell histiocytosis (LCH) is a rare clonal proliferative disorder of immature dendritic cells that expresses an immunophenotype positive for S100 protein, CD1a and langerin (CD207) and contains cytoplasmic Birbeck granules. We present a case of multisystem LCH with risk organ (liver) and special site (craniofacial) involvement in a 4-year-old boy who presented with hypopigmented papulopustular lesions with scales over his scalp, face and trunk, along with polydipsia, polyuria and pain in the abdomen. Histopathology reports showed diffuse infiltration of large cells with eccentric grooved coffee bean nuclei with epidermotropism and admixed with numerous eosinophils. The patient was started on desmopressin, prednisolone and chemotherapy with vinblastine. Our goal is to expand awareness regarding the entity through this report.

Pustular Pyoderma Gangrenosum with Ulcerative Colitis an Uncommonly Seen Association

We report a case of a 36-year-old female having ulcerative colitis who had multiple papulo-pustular lesions over trunk and face. She had received treatment as acne vulgaris but due to lack of satisfactory response, histopathological evaluation was done which was consistent with pustular pyoderma gangrenosum. The diagnosis of pustular pyoderma gangrenosum is often challenging as there is no defining diagnostic clinical, laboratory or histopathological feature. Thus a high index of suspicion is essential to diagnose this condition.

Microencapsulated Benzoyl Peroxide for Rosacea in Context: A Review of the Current Treatment Landscape.

Rosacea, a chronic skin condition affecting millions of people in the USA, leads to significant social and professional stigmatization. Effective management strategies are crucial to alleviate symptoms and improve patients' quality of life. Encapsulated benzoyl peroxide 5% (E-BPO 5%) is a newly FDA-approved topical treatment for rosacea that shows promise in enhancing therapeutic response and minimizing skin irritation. This review aims to assess the role of recently FDA approved E-BPO 5% in the current treatment landscape for rosacea management, as it is not yet included in clinical guidelines that predominantly rely on older approved therapies. The review focuses on randomized controlled trials conducted in English-speaking adults. It evaluates the efficacy, safety, and tolerability of various US Food and Drug Administration (FDA)-approved agents used for rosacea treatment, including E-BPO cream, metronidazole gel, azelaic acid gel and foam, ivermectin cream, minocycline foam, oral doxycycline, brimonidine gel, and oxymetazoline HCl cream. Existing therapies have been effective in reducing papulopustular lesions and erythema associated with rosacea for many years. E-BPO 5% offers a promising addition to the treatment options due to its microencapsulation technology, which prolongs drug delivery time and aims to improve therapeutic response while minimizing skin irritation. Further research is necessary to determine the exact role of E-BPO 5% in the therapeutic landscape for rosacea. However, based on available evidence, E-BPO 5% shows potential as a valuable treatment option for managing inflammatory lesions of rosacea, and it may offer benefits to patients including: rapid onset of action, demonstrated efficacy by Week 2, excellent tolerability, and sustained long-term results for up to 52 weeks of treatment.

Dose-Related Aripiprazole-Induced Acneiform Rash: About A Case

Acneiform rash is a commonly reported side effect with certain types of medications, including antipsychotic agents. Its clinical presentation consists mainly of papulopustular lesions. Other types of lesions, such as nodular or cystic, can also be observed [1, 2]. Here we present a case of aripiprazole-induced acneiform eruptions with dose-dependent severity.

Validation of the PEDiatric Behçet's Disease classification criteria: an evidence-based approach.

to validate the PEDiatric Behçet's Disease classification criteria (PEDBD) with an evidence-based approach. 210 pediatric patients (70 Behçet's disease (BD), 40 Periodic Fever, Aphthous stomatitis, Pharyngitis, Adenitis, 35 familial Mediterranean fever, 26 hyper-IgD syndrome, 22 TNF-Receptor associated Periodic fever Syndrome, 17 undefined recurrent fevers) were randomly selected from the Eurofever Registry. A set of 11 experienced clinicians/researchers blinded to the original diagnosis evaluated the patients. Using the table consensus as gold standard (agreement ≥ 80%), the PEDBD, ISG and ICBD criteria were applied to BD patients and to confounding diseases with other autoinflammatory conditions in order to define their sensitivity, specificity and accuracy. At the end of the third round, a consensus was reached in 139/210 patients (66.2%). The patients with a consensus ≥80% were classified as confirmed-BD (n = 24), and those with an agreement of 60-79% as probable-BD (n = 10). When comparing these patients with the confounding diseases group, an older age at disease onset, the presence of oral and genital ulcers, skin papulo-pustular lesions, a positive pathergy test and posterior uveitis were BD distinctive elements. The ISG, ICBD and PEDBD criteria were applied to confirmed-BD and to the confounding disease group, showing a sensitivity of 0.50, 0.79 and 0.58, a specificity of 1.00, 0.97, 0.99, and an accuracy of 0.91, 0.94 and 0.92, respectively. the PEDBD criteria were very specific, while the ICBD resulted to be more sensitive. The complexity of childhood BD suggests larger prospective international cohorts to further evaluate the performance of the criteria.

Epidermal growth factor receptor inhibitor Geftinib-induced erosive pustular dermatosis of the scalp – A report with a brief review of the literature

Gefitinib is an epidermal growth factor receptor inhibitor used in the treatment of non-small cell carcinoma of the lungs, adenocarcinoma of the lungs, and solid malignancies of the head and neck region. A 65-year-old female patient with non-small cell carcinoma lung with bone metastasis was started on gefitinib monotherapy after which the patient noticed papulo-pustular lesions on the scalp, later leading to loss of hair. Dermatological examination revealed erythema, pustules with crusting, along with matting of the hair on the frontoparietal area with some areas of hair loss. Trichoscopic examination showed the absence of follicular openings indicating scarring alopecia. Skin biopsy showed perivascular mixed infiltrate of lymphocytes and neutrophils and absent hair follicles, consistent with gefitinib-induced erosive pustular dermatosis of the scalp, a rare entity.

Atypical perianal and buttocks epidermal-dermal necrosis in Human Monkeypox. Histopathological study of the lesion in Peru

We report the histopathological study of a large, black, crusted lesion with symmetrical distribution in both buttocks and perineum, never described, in a man who has sex with men (MSM) and proctitis associated with Human Monkey Pox Virus (hMPXV) and HIV-AIDS infection never treated. A 39-year-old male, homosexual, HIV-AIDS without Highly Active Antiretroviral Therapy (HAART), was admitted to a hospital in Lima, Peru, with papulopustular lesions on the body and perianal area. Days later, a large, crusty, black lesion with a symmetrical distribution appeared on the buttocks and perineum. The tissue culture was negative. Wedge biopsy of the lesion showed typical MPXV cytopathogenics lesions in addition to fibrin micro thrombosis in the underlying papillary dermis. The histopathological findings of the scabby and black lesion are the classic ones described by Stagles, except for the phenomenon of fibrin micro thrombosis in the papillary dermis, a novel cytopathogenic effect of MPXV with clinical relevance (epidermal-dermal necrosis).

Clinical features of Behçet's disease and prediction of the use of biologics in 488 cases: a single tertiary center study.

The objectives are to describe the demographic and clinical properties of Behçet's disease (BD) and investigate their relationship with the use of biological agents. Four hundred-eighty-eight patients, (299 (61.3%) males, 189 (38.7%) females), who fulfilled the ISG classification criteria for BD were included, retrospectively. The patient's demographics, disease onset age (DOA), clinical findings of the disease, and the drugs were determined and analyzed statistically. The means of patient age and DOA were 40.7±9.9 and 30.8±8.8 years, respectively. The most common initial findings were oral ulcer (OU)s (30.1%), genital ulcer (GU) (27.5%), ocular involvement (OI) (12.5%), and papulopustular lesion (PPL)s (10.1%). The most common clinical manifestations were OUs (96.9%), PPLs (70.2%), HLA-B51 (64.4%), positive pathergy reaction (26.4%), GU (58.8%), OI (44.7%), erythema nodosum (29.8%), and vascular involvement (VSI) (27.3%). Although, the frequency of GU was higher in females (p=0.01), PPLs (p =0.001) and VSI (p=0.001) were higher in males. Sixty-three (8.9%) patients used a biological agent. Its frequency was higher in younger patients (<40 years) (p =0.006), males (p=0.012) and patients with OI (p=0.001). Besides, the DOA (p=0.012) and the current age (p=0.001) were lower in biological agent users. The possibility of using biological agent was increased in males (OR=2.2), patients with OI (OR=2.7) and young patients (OR=0.9). Mucocutaneous lesions are distinctive features of BD, especially OUs precede other findings. GU was more common in females and PPLs and VSI were in males. The probability of using biologics is higher in males, patients with OI, and young patients.

Papulpustular dermatoses of the face, clinicopathological spectrum and response to treatment

The papulopustular rash on face may be a feature of several inflammatory skin disorders. Clinical features may provide clue to the etiology whereas microbiological testing and histopathologic examination confirm the diagnosis. In adults, facial papulopustular dermatoses include rosacea, perioral dermatitis, eosinophilic folliculitis, infections and medication induced. Our aim was to study variable causes of papulopustular lesions of the face. We conducted a prospective study which included 60 dermatology outpatient clinic patients of variable age groups whom presented with papulopustular lesions involving the face and review their clinicopathological findings as well as their response to therapy. Several diseases were reported including rosacea (47%), demodecosis (20%), bacterial folliculitis (13%), drug induced (7%) and periorificial dermatitis (3%). One case of tinea barbae, pityriosporum folliculitis, eosinophilic folliculitis, lupus miliaris disseminatus faciei, Behcet's disease and perforating folliculitis were reported. In conclusions; Papulopustular dermatoses involving the face are an important problem among dermatology patients with an overlapping in signs and symptoms. Awareness of various causes and their clincopathological features is important for accurate diagnosis and proper management.

5-Aminolevulinic acid photodynamic therapy versus minocycline for moderate-to-severe rosacea: A single-center, randomized, evaluator-blind controlled study

5-Aminolevulinic acid photodynamic therapy (ALA-PDT) showed potential to treat rosacea according to recent studies, but a lack of clinical evidence and unclear adverse effects limit its use. To compare the effect of ALA-PDT versus minocycline for rosacea. In this single-center, randomized, evaluator-blind, controlled study, patients with moderate to severe rosacea were allocated to receive 3 to 5 sessions of ALA-PDT or 8 weeks of 100 mg daily minocycline treatment, followed by a 24-week follow-up. Of all the 44 randomized patients, 41 received complete treatment (ALA-PDT 20, Minocycline 21). At the end of treatment, ALA-PDT showed non-inferior improvement of papulopustular lesions and Rosacea-related Quality of Life (RosaQoL) compared to minocycline (median reduction of lesion count: 19 vs. 22, median change of RosaQoL score: 0.48 vs. 0.53). The Clinician's Erythema Assessment (CEA) success of ALA-PDT was lower than minocycline's (35% vs. 67%). Demodex density and relapse rate were comparable in both groups. Erythema, mild pain and exudation were the most common adverse reactions of ALA-PDT. Limited sample size restricted us from drawing further conclusions. As minocycline does, ALA-PDT can improve rosacea mainly in papulopustular lesions and patients' quality of life, indicating a new option for rosacea.

Evaluation of inflammatory status in blood in patients with rosacea

Rosacea is a chronic inflammatory skin disease that is characterized by recurrent episodes of erythema, telangiectasia and papulopustular lesions. Although the pathogenesis is not well established, growing knowledge suggests that multiple etiological factors play a role resulting in inflammation. The aim of the present study is to investigate inflammatory status of patients with rosacea by evaluating CBC parameters and systemic immune inflammation (SII) index and compare these parameters with control group. Thus, it is aimed to understand the role of systemic inflammation in the pathogenesis of the disease. This retrospective, case–control study included 100 patients with rosacea and 58 sex- and age-matched controls. Laboratory examinations including CBC, ESR, CRP, HDL, LDL, and triglyceride levels were recorded and neutrophil–lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR), monocyte-to-high-density lipoprotein ratio (MHR) and SII index were calculated. Monocyte and platelet count, SII index, ESR and CRP were significantly higher in patients with rosacea than in the control group. No statistically significant difference was found in other parameters. There was no significant correlation between disease severity and ESR, CRP, and SII index. The findings of this study suggest that apart from the inflammatory pathways at the level of skin, there is an inflammatory state in the blood of patients. Rosacea is a skin disease, but it may have systemic implications and/or associations that need to be clarified completely.

Placement of High Dose Neurotoxins for Treatment-Resistant Rosacea.

Rosacea is a chronic inflammatory skin condition characterized by facial flushing, erythema, telangiectasias, and papulopustular lesions. Treatment for rosacea includes limiting inciting factors and reducing inflammation with topical and oral therapies. Traditional therapies primarily focus on the papulopustular or background erythematotelangiectatic component of rosacea, leaving symptoms of flushing poorly controlled and profoundly impacting the quality of life of patients. Neuromodulators have been speculated to improve the flushing component of rosacea by reducing mast cell degranulation and the release of neuropeptides. However, its use for symptomatic relief in refractory flushing rosacea has been limited by side effects such as facial muscle weakness or paralysis. We present the use of strategic placement of high-dose neuromodulators for treatment-resistant rosacea. This approach has resulted in the gradual stabilization of symptoms, improved quality of life, and superior side effect profile. Silence C, Kourosh AS, Gilbert E. Placement of high-dose neurotoxins for treatment-resistant rosacea. J Drugs Dermatol. 2023;22(6):605-606. doi:10.36849/JDD.7237.

Risk factors of cardiovascular involvement in patients with Behcet's disease

ObjectivesBehcet's disease (BD) is a multi-systemic inflammatory vasculitis which may be life-threatening if combined with cardiovascular problems. The aim of the study was to identify potential risk factors associated with cardiovascular involvement in BD. MethodsWe reviewed the medical databases of a single center. All BD patients identified as fulfilling the 1990 International Study Group criteria or the International Criteria for Behcet's Disease criteria. Cardiovascular involvement, clinical manifestations, laboratory features, and treatments were recorded. The relationship between parameters and cardiovascular involvement was analyzed. Results111 BD patients were included: 21 (18.9%) had documented cardiovascular involvement (CV BD group) and 99 (81.1%) had no cardiovascular involvement (non-CV BD group). Compared with non-CV BD, the proportion of males and smokers were significantly increased in CV BD (p = 0.024 and p < 0.001, respectively). Levels of activated partial thromboplastin time (APTT), cardiac troponin I and C-reactive protein were significantly higher (p = 0.001, p = 0.031, and p = 0.034, respectively) in the CV BD group. Cardiovascular involvement was associated with smoking state, the presence of papulopustular lesions, and higher APTT in multivariate analyzed (p = 0.029, p = 0.021, and p = 0.006, respectively). The ROC curve showed that APTT predicts the risk of cardiovascular involvement (p < 0.01) at a cut-off value of 33.15 s with a sensitivity of 57.1% and specificity of 82.2%. ConclusionCardiovascular involvement in BD patients was associated with gender, smoking state, the presence of papulopustular lesions, and higher APTT. All patients newly diagnosed with BD should be systematically screened for cardiovascular involvement.

Nairobi fly dermatitis cases in Ade charake village in Bodit town Administration, Wolaita Zone, SNNPR, Ethiopia, 2018

Background: Nairobi fly dermatitis is unusual form of contact dermatitis caused by pederine, ahemolymph fluid released when the insects are crushed against the skin. Patients often present with a sudden onset burning sensation and cutaneous pain. The insects are belonging to the genus Paederus. These insects are found worldwide, although the concentration is higher in tropical and subtropical areas. In Ethiopia, more particularly in Wolaita, Nairobi fly dermatitis is uncommon previously. Hence, we aimed to describe the clinical characteristics and identify risk factors prone to the disease. Methods: We conducted unmatched case-control study (ratio 1:2) with 45 cases and 90 controls from April 5 to 14, 2018 in Ade charake Village, Southern Ethiopia. Cases were patients who had a history of linear dermatitis, kissing/mirror image/ lesions, multiple vesiculo-pustular lesion, extensive pustules, blistering and papulo-pustular lesions over face, neck, arms, shoulders, axillaries region, lower limbs, chest, upper limbs or any other area of the body in Ade Charake Village in the study period. Controls were asymptomatic individuals selected randomly from the households or neighbors during the outbreak period. The investigators initially developed a clinical-epidemiological questionnaire to obtain data from cases as well as controls. Basic descriptive summary including attack rate, in addition to bivariate and multivariable logistic regression was computed. The odds ratio was computed at 95% CI with a P-value &lt;=0.05 to ascertain the association. Results: Among 45 cases, 60 %( 27/45) were females. The commonly affected age groups were between 8-15 years 31% (14/45). The frequently appearing clinical manifestation was Erythmato-vesicular lesions 40% (18/45) and most patients 71% (32/45) presented with a complain of burning sensation followed by pruritus 62% (28/45).We found that use of light during sleep (AOR=8.5,95% CI, 1.033-64.8), disposing wastes near vicinity(AOR=5.44, 95% CI 2.094,14.1250) and proximity of dense vegetations or fruit in the vicinity (AOR=7,95% CI, 1.143-43.78) were risk factors to develop Nairobi fly dermatitis. Conclusion: We found that Nairobi fly dermatitis predominantly affects females while sleeping with light on and disposing of wastes near vicinity. The presence vegetation’s and/or fruits in the neighborhood found to be the risk factors for Nairobi fly dermatitis.

Papulopustular periorbital demodicosis: A diagnosis often overlooked

Demodicosis is the term given for cutaneous diseases caused by the human ectoparasitic mites Demodex folliculorum and Demodex brevis which are common commensals of the pilosebaceous units in human beings. We report a 72-year-old female who presented with erythematous papulopustular lesions over both upper and lower eyelids and a few similar lesions on the cheeks of 2 weeks duration with one similar episode in the past. A cyanoacrylate standardized skin surface biopsy showed increased mite density and the patient was successfully treated with acaricides. Demodicosis is often misdiagnosed as contact dermatitis, papulopustular rosacea, or seborrheic dermatitis. A high index of suspicion of demodicosis is needed to arrive at an accurate diagnosis.

Dramatic response to colchicine treatment in acne fulminans patients with cytological hemophagocytosis: A case series of 12 patients.

Acne fulminans is a severe form of acne with a sudden onset, rapid ulceration of the lesions, and some systemic symptoms, with or without systemic symptoms. These papulopustular lesions, whose pathogenesis is not fully understood, may exacerbate with systemic isotretinoin or may be a component of some autoinflammatory syndromes. It is recommended to control these sudden pustular attacks with systemic steroids or anti-inflammatory drugs. Here, in 12 patients with acne fulminans who developed exacerbation during systemic isotretinoin treatment and whose cytological examination revealed hemophagocytosis, colchicine treatment was started in addition to low-dose isotretinoin treatment, and a very good response was obtained to this treatment approach that did not contain systemic corticosteroids.

A Case Report The Evaluation of Malondialdehyde Level on Acne Vulgaris Treatment

Abstract: Acne vulgaris (AV) is a multifactorial disease of the pilosebaceous unit with varying degrees of severity, recurrent and characterized by polymorphic lesions. Recent studies have found that the etiopathogenesis of AV is caused by oxidative stress. Each factor that causes AV is interrelated and is under the control of hormones and immunity. Measurement of malondialdehyde (MDA) level in the blood becomes a biological marker or an indicator of cell and tissue damage caused by oxidative stress. Case: A 23-years-old female private employee visited the clinic for multiple comedones and papulopustular lesions scattered over cheeks, nose, and chin that spread to the whole face four months ago. There were multiple comedones, papules, pustules, nodules on the maxillary, nasalis, left and right zigomatic, mentalis and frontalis region. We also found multiple scars on the left and right buccal. She was diagnosed with Severe AV. Serum MDA level was measured according to the enzyme-linked immunosorbent assay (ELISA) method before and after therapy. She was treated with doxycycline 100 mg, 0.025% tretinoin cream, 5% benzoyl peroxide, 1.2% clindamycin gel, and broadspectrum sunscreen with SPF 50. Result: After eight weeks of treatment, there were noticeable improvements in acne lesions and overall healthier-looking skin. Serum MDA levels are decreased (22.6 nmol/ml to 17.9 nmol/ml) as the impact of the therapy.&#x0D; Keyword: Acne Vulgaris, Malondialdehyde, Oxidative Stress

Clinico-laboratory findings of Malassezia folliculitis in Indonesia: A multicentre study.

Malassezia folliculitis (MF) is a humid-favoured fungal skin disease caused by Malassezia species. Inaccurate treatments, changes in skin flora and disease exacerbation are often occurred due to oversights in the diagnosis. Several diagnostic methods are established for MF. To identify clinico-laboratory findings of Malassezia folliculitis in Indonesia. The study was conducted from January 2014 to December 2018 in seven referral teaching hospitals. Medical records of MF-diagnosed patients were obtained and analysed using the binomial test, chi-square test and Cohen's Kappa coefficient in SPSS 26.0. A total of 353 cases of MF were identified in seven referral teaching hospitals in Indonesia, 66.3% of which were males and 33.7% were females, dominated by the 17-25 years old group (44.5%). Itchy sensation (83.9%) was a major subjective complaint. Lesions were majorly found on the trunk-chest, back and shoulder (68.3%), while the clinical manifestation are mostly follicular papule-pustular lesions (62.1%). Patients were 87.4% positive by KOH examination (modified Jacinto Jamora's criteria) and 69.1% positive by Wood's lamp. Generally, sex, age, subjective complaint, lesion location, clinical manifestation and both examinations were statistically significant (p < .001). A significant relationship between all the clinical criteria of the patients in the KOH especially the clinical manifestation was significantly related to Wood's lamp. The Cohen's Kappa assessment suggested that there was an agreement between KOH and Wood's lamp (κ=-0.272, p < .001). The clinical symptoms of Malassezia folliculitis are dominated by pruritus, papulopustular follicular lesions on the trunk and the presence of spore load.

HLA-B51 Impact on Clinical Symptoms in Behcet's Disease.

To investigate the association of HLA-B51-positivity to clinical manifestations of Behçet's disease (BD). Descriptive study. Clinic of Rheumatology, Dıskapi Education and Research Hospital, Health Sciences University, Turkey, from December 2018 to December 2020. Patients who had HLA-B5 genetic results and fulfilled the international criteria for BD were included in the study. HLA-B51 status was determined and compared with the symptomatology. Mean age of 204 cases was 39.9±11.4 years. There were 52.5% female and 47.5% male patients. One hundred (61.7%) patients were HLA-B51-positive. The frequency of papulopustular lesions (PPL), ocular involvement, neurologic involvement, and vascular involvement was significantly higher in HLA-B51-positive patients compared to HLA-B51 negative patients (p=0.044, 0.012, 0.039, and 0.022 respectively). HLA-B51-positivity was found to be a significant risk factor for PPL (OR and 95% CI:1.946 and 1.044-3.629), ocular involvement (OR and 95% CI:2.399 and 1.165-4.938), and neurological involvement (OR and 95% CI:5.404 and 1.119-26.093). Significant risk factors for vascular involvement were male gender (OR and 95% CI:2.810 and 1.403-5.627) and low age of disease onset (OR and 95% CI:0.935 and 0.894-0.979). Ocular, vascular, and neurological involvements are more common in patients with BD with HLA-B51-positive. HLA-B51 was found to be an independent risk factor for papulopustular lesion, ocular and neurological involvement, while the male gender was found to be an independent risk factor for vascular involvement. Behcet syndrome / genetics, HLA-B51, Neurologic involvement, Ocular involvement, Vascular involvement, Vasculitis* / diagnosis.