The pathergy test (PT) is a minimally invasive method that examines the hyperreactivity response of the skin to needle application. In the International Study Group for Behcet’s Disease (ISG) criteria system, the sensitivity and specificity are stated as 58% and 90%, respectively. Based on data reported worldwide, the positivity rates of the PT have shown a consistent decrease over the years in all countries. Similar to other manifestations of Behcet’s disease (BD), the pathergy reaction (PR) exhibits fluctuations throughout the course of the disease, displaying increases and decreases in line with the primary characteristics of BD. The relationship between PT positivity and disease severity remains contradictory across reported studies. The lack of standardization in the application of PT across clinics, together with variations in positivity rates by race, undermines its general validity. However, the importance of PT may increase with the development of new methods to increase its sensitivity for early diagnosis of BD and prevention of associated morbidities.