How can I differentiate Behçet's disease from other causes of recurrent oral ulcers in my patients?

Behçet's disease can be differentiated from other causes of recurrent oral ulcers primarily by its characteristic clinical features and systemic involvement. While recurrent oral aphthous ulcers are common in many conditions, Behçet's disease typically presents with painful, recurrent oral ulcers accompanied by genital ulcers and ocular inflammation (e.g., uveitis), which are less common in other causes ¹ (Mat et al., 2013). The oral ulcers in Behçet's are often larger, deeper, and more persistent than typical aphthous ulcers ¹ (Field and Allan, 2003). Additionally, Behçet's disease may involve skin lesions, arthritis, vascular, neurological, and gastrointestinal symptoms, which help distinguish it from isolated recurrent aphthous stomatitis or other ulcerative conditions ¹ (Mat et al., 2013).

Diagnostic criteria for Behçet's disease include recurrent oral ulceration plus at least two of the following: recurrent genital ulceration, eye lesions, skin lesions, or a positive pathergy test ¹ (Mat et al., 2013). This systemic pattern is key to differentiation. In contrast, common causes of recurrent oral ulcers such as aphthous stomatitis lack systemic features and have a more benign course ¹ (Field and Allan, 2003).

Investigations may include referral for ophthalmologic assessment to detect uveitis and other ocular signs, and consideration of pathergy testing, although the latter is not universally available or sensitive ¹ (Mat et al., 2013). Misdiagnosis can occur, especially when ocular or genital symptoms are subtle or absent initially, so a thorough history and examination for systemic signs are essential (Wang et al., 2016).

In summary, differentiating Behçet's disease from other causes of recurrent oral ulcers relies on identifying systemic involvement—particularly genital ulcers and ocular inflammation—and applying established diagnostic criteria, supported by clinical judgment and specialist referral when needed ¹ (Mat et al., 2013; Wang et al., 2016).