The neurological complications of Behçet's syndrome have not been characterized with clarity. We present the clinical features, imaging characteristics and CSF findings of a series of 50 patients seen at the National Hospital for Neurology and Neurosurgery over the past 10 years. In this series, vascular complications had a low prevalence, whereas involvement of the brainstem was common; spinal cord lesions, hemisphere lesions and meningoencephalitis also occurred. Optic neuropathy, vestibulocochlear and peripheral nerve involvement occurred, but were rare. The prognosis for recovery was in general good, and the majority of those followed-up over a median of 3 years (range 1-19 years) had only single attacks. One-third of patients underwent further attacks, and four underwent progressive deterioration leading to disability. Factors suggesting a poor prognosis are repeated attacks, incomplete recovery, progressive disease course and a high level of CSF leucocytosis during acute attack. These data should be of help in the further definition of the clinical characteristics of this rare neurological disorder and in the planning of treatment trials.

In our population, BD confers a 14-fold risk of developing venous thrombosis. The risk is sixfold higher in male BD patients, who fare worse than females with regard to thrombophlebitis, folliculitis and retinal vasculitis.

describe was stung by the P noctiluca species. Furthermore, to our knowledge, the RCM characteristics of jellyfish sting have not been described to date. In this patient, RCM proved useful to identify the presence of nematocysts in the epidermis, confirming the clinical diagnosis of jellyfish sting and the related persistence of symptoms. Remarkably, in the follow-up visit after topical therapy, the dermoscopic and RCM features appeared dramatically reduced or no longer visible, paralleling the resolution of symptoms and supporting the decision to discontinue treatment.Conclusions | In conclusion, although further studies are needed to validate these observations, in vivo skin imaging may represent an adjunctive and valuable tool to confirm clinical diagnosis and monitor treatment response over time in patients with jellyfish stings.

Conflict of Interest Disclosures: Dr Pomeranz reported being a paid member of the scientific advisory board of Procter & Gamble and receiving royalties from UpToDate. Dr Femia reported receiving royalties from UpToDate. No other disclosures were reported.

To the Editor: Lichen sclerosus (LS) is a chronic, inflammatory disorder that may lead to anogenital malignancy and scarring. 1,2 The pathophysiology is poorly understood; although autoantibodies targeting extracellular matrix 1 protein and the basement membrane zone have been identified, experts favor a T-cellemediated pathogenesis. 1,2 Small studies show an association with thyroid disorders, vitiligo, and psoriasis. [1][2][3] Increased risk of vulvar squamous cell carcinoma is also reported, with a lifetime incidence of 0.4% to 6% in women with LS. 4 We sought to determine the prevalence of these commonly cited comorbidities in the largest cohort of women with LS to date.The study population included patients in the IBM MarketScan Databases from 2015 to 2017 with 2 or more independent diagnoses of LS (International Classification of Diseases, 10th RevisioneClinical Modification L90.0). This database comprises more than 21.7 million commercially insured women in the United States. The study population was compared to a control group of women without LS. Stata statistical analysis software version 15.0 (StataCorp, College Station, TX) was used to examine the prevalences of Hashimoto disease/chronic lymphocytic thyroiditis/autoimmune thyroiditis, Graves disease/thyrotoxicosis, vitiligo, psoriasis, and vulvar carcinoma. Odds ratios and 95% confidence intervals were calculated. A P value of \.05 was considered significant.We identified 10,004 women with LS and 21,672,016 female control individuals without LS from 2015 to 2017 in the United States. The mean age was 50.8 years; 79% were between 45 and 65 years old. The rates of comorbid conditions are shown in Table I. In the LS population, the prevalences were as follows: autoimmune thyroid diseases, 6.11%; vitiligo, 1.95%; psoriasis, 5.12%; and vulvar carcinoma, 1.9%. All comorbidities were more likely to occur in patients with LS compared to control individuals (Table II). The most commonly associated autoimmune disease was hypothyroidism, with a prevalence of 4.26%. Notably, vulvar carcinoma was 26 times more likely and vitiligo was 12 times more likely to occur in patients with LS.We identified only 4 studies that examined the rates of similar comorbidities in LS. [1][2][3]5 One comparing 50 patients with LS to 50 control individuals cited an autoimmune disease prevalence This project was accomplished through a generous gift from The Louis and Rachel Rudin Foundation, Inc, which supports the research education of residents at New York University Langone Health's Ronald O. Perelman Department of Dermatology.