Mouth and nose sores — often called ulcers — are common symptoms of systemic lupus erythematosus (SLE), the most common type of lupus. These ulcers are sometimes painful, but not always.

During disease flares — periods when your symptoms worsen — mouth and nose sores can show up or get worse. But they can also happen when your disease is inactive, or in remission. Even if mouth and nose sores aren’t painful, they can affect your quality of life by making it harder to talk, eat, or drink.

Mouth and nose sores might be an unexpected symptom of your lupus. Here’s what you need to know about these sores with lupus, including what causes them, how to treat them, and some pictures of different types.

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What Do Mouth and Nose Sores With Lupus Feel Like?

Lupus-related ulcers in the mouth can feel similar to canker sores, though they are often painless. They most often appear on the inner cheeks and lips, the roof of the mouth, and on the lower lip.

Between 8 percent and 45 percent of people with SLE experience nose and mouth sores — a common sign of a lupus flare-up.

You may feel burning, tingling, pain, or irritation. While not everyone will have mouth sores that hurt, for some, the pain can be severe. “I can barely talk. Even drinking water is painful,” shared one MyLupusTeam member, when describing their mouth sores.

What Do Mouth and Nose Sores With Lupus Look Like?

Ulcers often look like reddish spots on the skin with a white halo and white lines spreading out from the center. They can also be white or silvery, with redness around them. And what do lupus nose sores look like? These sores are harder to see. Nasal ulcers usually develop on the septum, which is the wall between the nostrils.

What Causes Oral and Nasal Sores in People With Lupus?

Mouth and nose sores may be a sign of SLE and may help doctors make an initial diagnosis. Studies suggest that people with SLE who have had lupus for longer and have oral hygiene problems are at higher risk for nose and mouth ulcers. These sores are a type of lupus skin involvement. Your skin is one of the organs most commonly affected by SLE.

Sores in your nose and mouth may be directly caused by lupus. However, in up to 40 percent of people with lupus, the sores are not caused by the disease itself. In these cases, sores may be caused by a medication or another health condition.

Active Lupus

Between 8 percent and 45 percent of people with SLE experience lupus nose sores and mouth sores. These can also be symptoms of other types of lupus, such as acute cutaneous lupus erythematosus and discoid lupus erythematosus. These ulcers are often a sign of active lupus or a lupus flare-up.

Sjögren’s disease is a common cause of mouth symptoms in people with lupus.

If your sores are caused by active lupus, they are usually red and surrounded by a white border. These are sometimes called discoid lesions.

Other Autoimmune Diseases

A survey by the Lupus Foundation of America found that about one-third of people with lupus have at least one other autoimmune disease. Some other autoimmune diseases can also cause mouth ulcers. Inflammatory autoimmune diseases that may cause mouth sores include Behcet’s disease, celiac disease, and ulcerative colitis.

Sjögren’s disease is an autoimmune disorder that’s more common in people with lupus. It causes dry mouth, which can lead to mouth ulcers. Because of this, Sjögren’s disease is a common cause of oral symptoms in people with lupus. Studies vary on how common Sjögren’s is in people with SLE. Some report between 9 percent and 33 percent, while others report 14 percent to 18 percent. Even so, scientists agree that Sjögren’s disease is a major cause of mouth and eye complications in people with lupus.

Lupus Treatments and Other Medications

Some medications used to treat lupus may cause mouth ulcers as a side effect. These include:

• Methotrexate, a drug used to reduce inflammation, can cause painful sores in the mouth.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are common anti-inflammatory medicines. They are known to contribute to sores by slowing the body’s ability to heal minor injuries to soft tissues or mucosal tissue (like that in your nose and mouth).
• Immunosuppressants, including glucocorticoids, may make sores worse. They can raise the risk of fungal, viral, or bacterial infections that cause mouth sores.

Other medications, like calcium channel blockers (used for blood pressure) and cholesterol-lowering medications, can also cause mouth problems, but this is rare.

Stevens-Johnson Syndrome

Stevens-Johnson syndrome (SJS) is a very rare but serious reaction to certain medications, including some used to treat lupus. This condition can cause painful sores in and around the mouth, along with crusting and peeling of the lips. SJS is a medical emergency that requires immediate care. In SJS, affected areas can spread quickly and merge to form large areas of skin peeling away.

More than 200 medications have been reported to cause SJS. Drugs most likely to cause it include sulfonamide antibiotics, certain seizure medicines (such as carbamazepine, phenytoin, lamotrigine), allopurinol, and oxicam-type NSAIDs.

Managing Nasal and Oral Ulcers With Lupus

If lesions in your nose or mouth don’t go away or begin to affect your daily life, talk to your healthcare provider. They can help find the cause of these sores. This may include a biopsy, which involves taking a small tissue sample to examine under a microscope. A biopsy can help show whether your sores are more likely to be caused by lupus, a side effect of a medication, or another condition.

“I can barely talk when I have mouth sores. Even drinking water is painful.”

— A MyLupusTeam member

Blood tests can also help check for vitamin deficiencies, such as low vitamin B12 or iron, which might contribute to ulcers.

Treating Lupus

Keeping your lupus well-controlled is one of the best ways to lower the risk of recurrent lupus mouth sores and nose sores. To manage SLE:

• Stick to your prescribed treatment plan.
• Eat a healthy, balanced diet.
• Stay physically active, as your energy allows.

Treating Mouth and Nose Sores

If you have mouth and nose ulcers caused by lupus, your healthcare provider can recommend treatment options. These may include:

• A mild, over-the-counter mouthwash without alcohol, or a saltwater rinse
• A medicated mouthwash with chlorhexidine or dexamethasone to reduce bacteria and inflammation
• A steroid nasal spray, topical steroid paste or ointment, such as triamcinolone dental paste, to reduce inflammation and help sores heal
• Corticosteroid pills, if topical steroids aren’t effective
• Topical numbing gels or rinses, such as those with benzocaine, to reduce pain (these are not recommended for young children)

For sensitive areas, like the face, long-term use of topical steroids can make the skin thinner and more fragile. If topical steroids are helping, your healthcare provider may suggest switching between them and another medicine called a topical calcineurin inhibitor (like pimecrolimus cream or tacrolimus ointment). This can lower your risk of skin thinning and other problems from using topical steroids for a long time.

Tips for Managing and Preventing Ulcers

To help reduce mouth and nose ulcers and reduce lupus flare-ups, consider these steps:

• Identify and avoid your lupus triggers, like sun exposure or certain foods.
• Manage stress by seeing a therapist, meditating, or practicing relaxation techniques.
• Avoid acidic or spicy foods when you have active ulcers to prevent irritation.
• Maintain good oral hygiene, including regular dental checkups.
• Use a soft-bristle toothbrush and gentle, nonabrasive toothpaste with fluoride.
• Talk to your doctor about whether any of your medications may be contributing to ulcers.

Join the Conversation

On MyLupusTeam, people share their experiences with lupus, get advice, and find support from others who understand.

How do you manage nose or mouth sores with lupus? Let others know in the comments below.

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