Immunomodulatory therapy for oral and genital ulcers

Colchicine has been used for prevention of oral and genital ulceration in Behçet syndrome, though evidence is conflicting for its efficacy in both prevention and treatment. It is often used in combination therapy with another immunomodulatory drugYazici, 2021.

If colchicine is indicated for prevention of oral and genital ulceration in Behçet syndrome, use:

colchicine 500 micrograms orally, once or twice daily. colchicine colchicine colchicine

Reduce colchicine dosage in people with kidney impairment. Patients taking colchicine long term should have monitoring of their full blood count and kidney function and be made aware of signs associated with colchicine toxicity (see Colchicine poisoning for further advice).

Oral corticosteroids may be used for the treatment of severe oral or genital ulceration. If indicated for severe oral or genital ulceration in Behçet syndrome, low-dose, short-term oral therapy is recommendedYazici, 2021; use:

prednisolone (or prednisone) 10 to 15 mg orally, daily until pain is controlled (typically 5 days), then taper the dose over 1 to 2 weeks to stop. prednis ol one prednis(ol)one prednis(ol)one

See Specific considerations for use of systemic corticosteroids for information on adverse effects associated with long-term corticosteroid use (such as bone density loss) and advice on how to minimise and monitor for such complications.

Apremilast is an immunomodulatory drug that can be effective in treating and preventing oral and genital ulcers in Behçet syndromeHatemi, 2018. It can reduce disease activity and improve quality of life. For resistant cases of oral and genital ulceration, other immunomodulatory drugs that may be used include azathioprine, interferon alfa, or a tumour necrosis factor (TNF) inhibitorHatemi, 2018.