Background It is well known that menstruation triggers several conditions such as migraine, recurrent aphtous stomatitis and acne vulgaris in otherwise healthy individuals (1). It may exacerbate chronic autoimmune diseases and familial Mediterranean fever (FMF) (2–4). There is also one study that briefly mentions menstruation causes activation in Behçet's syndrome (BS) (4).
Objectives We investigated the relationship between menstruation and specifically the skin-mucosa lesions of BS. As controls, we studied FMF patients.
Methods Premenopausal women with BS and FMF seen consecutively at the outpatient clinic of Cerrahpasa Medical Faculty at Istanbul, were interviewed. BS patients were asked whether they experienced increased skin-mucosa lesions during the menstrual period. A similar questionnaire assessing this time the frequency of serositis and fever attacks was given to the patients with FMF. As a control the participants were also asked whether they experienced headaches during the same period as well.
Results A total of 140 BS patients with a mean age of 36±8 and mean disease duration of 9±6 years were studied. While 21 (15%) were off treatment, 103 (74%) were using colchicine and the remaining were using other immunosuppressive agents. As shown in the Table, among BS patients, 78 (56%) associated at least one symptom with menstruation. The most commonly reported symptom related with menstruation was the papulopustular involvement (50%), followed by oral (30%) and genital ulcers (21%) and nodular lesions (21%).
We also studied 185 patients with FMF. Their mean age was 32±8 and mean disease duration was 12±8 years. All patients were using colchicine for a mean duration of 8±7 years. A total of 138 patients (75%) reported that their attacks overlapped with menstruation. These attacks included mostly peritonitis in 126 patients (68%), pleuritis in 102 (55%), and fever in 73 (40%).
Among both BS and FMF patients, similar number of patients (41% and 41%, respectively) reported that menstruation triggered headaches.
Conclusions This survey showed that, in about half of the patients with BS at least one skin mucosa lesion is exacerbated with menstruation. Most commonly reported were the papulopustular lesions. Menstruation had a stronger effect on FMF, triggering at least one symptom in about ¾ patients. The main limitation of the study was the self-reported assessment methodology, rather than a prospective diary assessment. Our findings provide further evidence that papulopustular lesions of BS and acne vulgaris are pathologically related (5).
Khanna N et al. Indian J Dermatol Venereol Leprol. 1991;
Akar S et al. Rheumatol Int. 2006;
Colangelo K et al. Rheumatology (Oxford). 2011;
Karadag O et al. Rheumatol Int. 2013;
Kutlubay Z et al. Clin Exp Rheumatol. 2015
Disclosure of Interest None declared