Laser Hair Removal As a Trigger for Pathergy Like Reactions in Patients with Behcet's Disease

A Second Case Report of Laser Hair Removal Triggering Pathergy-like Reactions in Behcet’s Disease

Behçet disease (BD) is an inflammatory vasculopathy that can affect multiple organ systems in the body. The syndrome was was characterized by Turkish dermatologist Hulusi Behçet in 1937. Professor Behcet recognized a triad of symptoms in his patients – namely recurrent aphthous stomatitis, relapsing uveitis, and genital ulceration. Bechet’s disease frequently starts young adulthood and has a remitting–relapsing course. It affects about 5 in 100,000 people in North American but as many as 400 in 100,000 in Turkey.

To review more about Behcet’s disease, please click on the following link:

Nicolau et al 2023

Back in 2016, we reviewed together an interesting case of pathergy developing in a patient with Behcet’s disease following laser hair removal.

Authors of a new paper now in 2023 present a second case of pathergy like skin reactions happening after laser hair removal.

This case was the case of a  25-year-old  male  patient  diagnosed  with  Behcet’s disease back in 2014.  At that time, he  presented  with  HLA-B51  positivity,  positive family history  of  BD,  recurrent  oral  and  genital  ulcers,  pseudofolliculitis  lesions,  positive  pathergy  test  and  recurrent  uveitis.  He  was  prescribed  azathioprine  50  mg/day  and  colchicine  0.5  mg/day  with  good control.  In  April  2022,  he  reported   new  skin  lesions  on his thighs and trunk starting  3  days  after  the  first  laser  treatment. At the time of  examination,  painless  pustules  were present on the anterior trunk, dorsal region,  and  thighs.  The azathioprine  dose  was  increased  to  75  mg/day and colchicine to 1 mg/day. Within 1  month,  the  patient  showed  a notably improvement in the skin lesions.

FROM: R Nicolau et al. Pathergy-like reaction induced by laser hair removal in a patient with Behçet disease. Reumatismo. 2023 Jul 17;75(2). Figure used with creative commons license.

Conclusion

I really liked this case report. It adds to the 2016 report by Van de Ree-Pellikaan et al and reminds us that laser hair removal must be added to the list of triggers that can induce pathergy-like reactions in patients with Behcet’s disease. Other examples of pathergy reported in the medical literature include dental braces for teeth straightening, exacerbation of synovitis after arthrocentesis, onset of uveitis following various intraocular injections, and the formation of aneurysms around vascular anastomoses.

REFERENCES

R Nicolau et al. Pathergy-like reaction induced by laser hair removal in a patient with Behçet disease. Reumatismo. 2023 Jul 17;75(2).

Van der Ree-Pellikaan C et al. Oral ulcerations after placement of orthodontic braces and skin pustules after laser hair removal: novel inducers of pathergy reactions in new-onset Behçet's disease. BMJ Case Rep. 2016 Mar 7;2016:bcr2014209208. doi: 10.1136/bcr-2014-209208.