Hamuryudan and colleagues [1] present their successful results with thalidomide for the treatment of mucocutaneous lesions of the Behcet syndrome. In a previous study, we showed that benzathine penicillin, 1.2 million U once every 3 weeks, is also effective in the prevention and treatment of these lesions [2]. We suggest that controlled studies comparing the effects of benzathine penicillin and thalidomide be done in patients with mucocutaneous lesions dominating the clinical picture. If equally effective, penicillin is more advantageous than thalidomide because the former has fewer side effects and is safe, even in pregnant women.

As Hamuryudan and colleagues state, thalidomide cannot be considered a true disease-modifying agent because symptoms of the disease generally recur soon after cessation of therapy. In this sense, penicillin and other conventional therapeutic agents (such as dapsone, levamisole, and colchicine) cannot be considered true disease-modifying agents, either. In addition, the effect of thalidomide and other conventional drugs on eye disease is generally not satisfactory [3]. Cytotoxic immunosuppressive drugs such as cyclophosphamide and azathioprine are more effective than conventional drugs for eye lesions, but they may have serious side effects [3]. The ideal drug for the treatment of the Behcet syndrome should have a long-lasting effect even after therapy has ended, have acceptable side effects, and be effective in the prevention and treatment of disease symptoms, including eye attacks. Unfortunately, therapy for the Behcet syndrome that is accepted throughout the world is not possible yet. In recent years, interferon- has gained popularity in the treatment of the syndrome. We showed that interferon- is effective for this disease, has long-lasting effects even after cessation of therapy, and is a promising agent for the treatment and prevention of eye lesions [4]. We believe that in patients with eye involvement in addition to mucocutaneous lesions, controlled comparative studies with interferon- and other agents are needed to establish a more definitive therapy for the Behcet syndrome.