Which drugs are reported to be successful in treating the mucocutaneous lesions of Behcets syndrome?
• Topical triamcinolone acetonide cream (0.1% in Orabase) or dexamethasone elixir (0.5 mg/5 mL) swish for 5 to 10 minutes and spit (but do not rinse) three times daily.
• Topical pimecrolimus in combination with topical corticosteroids.
• Topical sulcrafate (1 g/5 mL four times a day) with or without topical corticosteroids.
• Oral colchicine, 0.6 mg two to three times daily. Especially useful for erythema nodosum and genital ulcers.
• Prednisone 15 mg daily for 1 week with taper over 3 weeks.
• Patients who fail topicals and colchicine and cannot taper prednisone:
– Apremilast, 30 mg twice a day. This is likely the drug of choice. It is now FDA-approved for Behcet’s.
• Azathioprine, up to 2.5 mg/kg per day. Mycophenolate mofetil does not work as well as azathioprine.
• Tumor necrosis factor (TNF) α antagonists. Use with azathioprine.
• Interferon-α, 6 × 10 6 units three times a week for 3 months followed by 3 × 10 6 units three times a week.
• Others: dapsone, cyclosporine, thalidomide, interleukin (IL)-1 inhibitors.
