The pustular skin lesions in Behcet's syndrome are not sterile

Abstract

Background: The pustular skin lesions of Behçet's syndrome (BS) are clinically and histopathologically similar to ordinary acne, but BS patients get lesions at sites not commonly involved in acne, such as the legs and arms. The microbiology of these lesions has not been studied adequately. Objective: To make a detailed study of the microbiology of BS lesions. Methods: Subjects were patients with BS and acne vulgaris. Material was extracted from pustular lesions and directly plated to aerobic and anaerobic media by sterile swab. Anaerobic bacteria were identified using a commercial kit (API 20A). Aerobic bacteria were defined by standard procedures. Results: 58 BS patients and 37 acne patients were studied. Pustules were cultured from the following sites: BS patients (70 pustules): face (17), back (30), chest (2), arm (4), leg (17); acne patients (37 pustules): face (27), back (6), chest (1), arm (2), leg (1). At least one type of microorganism was grown from each pustule. Staphylococcus aureus (41/70, 58.6%, p = 0.008) and Prevotella spp (17/70, 24.3%, p = 0.002) were significantly more common in pustules from BS patients, and coagulase negative staphylococci (17/37, 45.9%, p = 0.007) in pustules from acne patients. Conclusions: The pustular lesions of BS are not usually sterile. The microbiology of these lesions is different from ordinary acne. It remains to be determined whether the infection is secondary or has any pathogenic implications.

Investigation of the association between Toll-like receptor 2 gene polymorphisms and Behçet's disease in Japanese patients

“…LPS-stimulated production of tumor necrosis factor-␣, interleukin (IL)-1, IL-6, and IL-8 is significantly elevated in BD patients [14]. Several gramnegative bacteria species have been frequently isolated in lesions of BD patients [35]. Therefore, it is assumed that HSP and LPS are potent triggers for the development of BD.…”

Behçet’s Syndrome

“…The first is the cluster of superficial vein thrombosis, deep vein thrombosis, and dural sinus thrombi [31]; the second cluster is that of acne, arthritis, and enthesitis. The association of acne with arthritis and the recent observation of the pustule lesions of BS being nonsterile brings into discussion a "reactive arthritis" type of disease mechanism, at least for this disease cluster [32]. The association with anti-Saccharomyces cerevisiae antibodies and the presence of inflammatory bowel disease is perhaps another disease cluster [33].…”

Behçet’s syndrome: Facts and controversies

“…Although they once were regarded as noninfectious sterile pustules, the latest studies showed the presence of coagulase-negative staphylococcus and provotella species in the lesions. 36 In a study with 17 patients with Behçet's syndrome and 6 with acne vulgaris, histopathologic examinations were made by a blinded dermatopathologist. Fifteen of the patients with Behçet's syndrome demonstrated a predominant perifollicular infiltrate, whereas two had a perivascular infiltrate.…”