Behçet’s disease (BD) is a chronic multisystemic disorder characterized by mucocutaneous lesions and involvement of various systems, necessitating a comprehensive diagnostic approach. While mucocutaneous findings are pivotal in BD diagnosis, the specificity of papulopustular lesions has long been debated. These lesions are often localized on the lower extremities but can also appear on other body parts, posing challenges due to their clinical resemblance to acne and nonspecific follicular lesions. Dermatopathological studies on papulopustular lesions have yielded controversial findings. According to the results of studies which had revealed findings ranging from leukocytoclastic vasculitis to milder neutrophilic vascular reactions, some authors have suggested selecting nonfollicular lesions on the trunk or extremities and including only those with vessel-based neutrophilic reaction or vasculitis as part of the diagnostic criteria. Conversely, others have revealed perifollicular infiltrate similarities with acne vulgaris suggesting a disease spectrum that includes papulopustular lesions characterized by vessel-associated neutrophilic reaction alongside follicle-based lesions. In addition, a microbiologic study comparing the pustules of BD and acne vulgaris indicates non-sterility in BD pustules, offering limited help in differentiation. While papulopustular lesions situated on non-acne-prone sites are more indicative of BD, considering the high prevalence of nonspecific follicular lesions in the general population, papulopustular lesions lacking specific clinical and dermatopathological features can present diagnostic complexities. This is especially significant in cases where the diagnosis heavily relies on this criterion.