A woman in her 50s presents with a large biopsy-proven BD lesion on her ankle. What would you do?

While there are no studies demonstrating strong evidence for beneficial therapies, several therapies are likely to beneficial on the basis of the evidence presented. Cryotherapy and ED&C are both likely to be beneficial and the patient may feel reassured about these therapies because they are destructive and are performed by the clinician. While PDT is also likely to be beneficial, it is not widely available. Topical 5-FU is also likely to be beneficial and can be used in patients who are either very compliant and/or would not otherwise tolerate a more invasive procedure. Intralesional interferon is also likely to be beneficial but will probably be a second-line agent because of its cost.

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