Androgen Receptor Levels of Oral and Genital Ulcers and Skin Pathergy Test in Patients with Behçet’s Disease

Abstract

Background: Hormonal factors have long been proposed to play a role in Behçet’s disease (BD). Male sex, systemic onset, HLA-B51 positivity and a younger age of onset in BD are associated with severer disease, and the disease generally runs a milder course in women. Vascular involvement is more common, and the skin pathergy test (SPT) is more strongly positive in men. BD rarely develops before puberty or after the age of 50 years. Clinical manifestations of the disease, with the exception of eye symptoms, tend to improve with time. Therefore, BD may be androgen driven to some degree. Objectives: We aimed to investigate androgen receptor (AR) levels of oral ulcers (OU), genital ulcers (GU) and SPT areas and compared them with those of adjacent normal-appearing skin/mucosa from patients with BD. Methods: Thirty-eight patients with BD (16 female, 22 male; mean ± SD age, 36.45 ± 10.2 years), diagnosed according to the criteria of the International Study Group for Behçet’s Disease, were included in the study with blind histological examination. Biopsies from OU of 10 patients, GU of 11 patients, SPT areas of 17 patients and adjacent (approximately 2 cm distant) normal-appearing skin/mucosa in patients with BD were performed. Nuclear AR levels were studied by an immunohistochemical technique, using monoclonal antibodies. The percentage of positively staining cells was recorded as the AR index (ARI). In addition, the prevalence and the positivity rate of SPT has also been evaluated. Results: ARI values in the lesional and control (non-lesional adjacent) skin/mucosa were found to be 14.5 versus 18% for OU, 28.7 versus 25.5% for GU and 36.3 versus 21.8% (p = 0.068) for SPT areas. The positive SPT areas in male patients showed a higher ARI than those of female patients (43.36 and 23.33%; p = 0.078). The ARI values of SPT areas in male patients but not in female patients were found to be significantly higher as compared with non-lesional skin (21.63%; p = 0.039). The SPT positivity was also more common in male patients compared with female patients (86.4% and 62.5%), although the difference was not significant (p = 0.88). SPT have been found to be more strongly positive among the males (4.63 ± 3.3) compared with female patients (3.18 ± 1.9), and the difference was statistically significant (p = 0.022). Conclusions: Our findings indicate that androgens seem to play a role both in the formation and increased positivity of the SPT areas in male patients with BD.

Exophytic Ulcerated Tumors in HIV Patients: Diagnostic and Therapeutic Problems

“…Patients with a CD4 blood cell count <100 cells/µl are considered as having persistent rather than self-limiting skin lesions [11]. The differential diagnosis of atypical genital ulcerations is broad [12] and includes both infectious and noninfectious conditions [13, 14]. Our patients presented with very unusual, persisting and painful ulcerated tumors resembling malignancies rather than viral infection.…”

Manifestations buccales de la maladie de Behçet. A propos de 12 cas au Sénégal

“…Ainsi, l'âge de survenue est situé entre 20 et 30 ans [2,8,10] et l'âge moyen entre 26 et 30,3 ans [2,5,12] . Et la maladie est rare avant la puberté ou après 50 ans [6,13,14] . L'atteinte pré-dominante des sujets de sexe masculin qui étaient au nombre de 8 (contre 4 de sexe féminin) s'inscrit dans les données de la littérature [2,8,10] .…”

Salivary Epidermal Growth Factor Levels in Behçet’s Disease and Recurrent Aphthous Stomatitis

“…Immunopathogenetic studies indicate that these ulcerations might be caused by cytotoxic action of lymphocytes and monocytes on the oral epithelium with an unknown trigger. Immunologic and/or cytokine aberration leading to local tissue destruction have also been implicated [2,3,4,6,7,8,9,10,11,12]. …”

“…The healthy oral mucosa responds to trauma or other external stimuli by initiating a series of homeostatic repair mechanisms involving a complex interaction between the cellular constituents of the mucosal tissue and the immune system [6,7,8,9]. In patients with RAS and BD, however, trauma to the oral mucosa instead leads to tissue damage and ulceration (isomorphic phenomenon) [6,7,8,9].…”

“…In patients with RAS and BD, however, trauma to the oral mucosa instead leads to tissue damage and ulceration (isomorphic phenomenon) [6,7,8,9]. The mechanism of the isomorphic phenomenon is not known.…”