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Mouth and Nose Sores in Lupus: Causes and Treatments

Updated on January 03, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Nyaka Mwanza

Mouth sores and nose sores, sometimes called ulcers, are common symptoms of lupus. Mouth and nose sores may be a first sign of the disease and may help lead to an initial diagnosis. Oral and nasal ulcers are also a common sign of lupus flares — periods when the disease is active and the symptoms are worse or more noticeable than usual. In fact, studies suggest that people with lupus are at greater risk of these ulcers the longer they have had lupus and if they have oral hygiene problems.

Lupus-related ulcers in the mouth can feel similar to canker sores. Mouth and nose sores (also known as mucosal ulcers) can range from uncomfortable to unbearably painful, especially if they’re not treated. “I can barely talk. Even drinking water is painful,” shared one MyLupusTeam member about their mouth sores.

Here’s what to know about why these sores form and what you can do to find relief.

What Causes Oral and Nasal Sores in People With Lupus?

Lupus ulcers are usually red with a white halo. Oral ulcers most often appear on the roof of the mouth, inside the cheeks, or on the lips. Nasal ulcers usually appear on the septum (the division between the nostrils) or on the thick central cartilage of the nose.

These mouth and nose sores may be a direct symptom of lupus, its treatment, or related conditions. In some cases, mouth sores may be unrelated to lupus and caused by factors such as stress, hormonal changes, or a nutritional deficiency.

Active Lupus

About 25 percent of people with lupus experience mouth and nose sores. By some estimates, 45 percent of people with systemic lupus erythematosus, the most common type of lupus, experience these sores. Mouth and nose sores can also be symptoms of other types of lupus, such as acute cutaneous lupus erythematosus and discoid lupus erythematosus. These ulcers are a common sign of active lupus or a lupus flare-up.

Other Autoimmune Diseases

Many other autoimmune diseases may also cause mouth ulcers, and one-third of people with lupus have at least one other autoimmune disorder. For example, inflammatory autoimmune diseases including Behcet’s disease, celiac disease, and inflammatory bowel disease can cause mouth sores. Sjogren’s syndrome is an autoimmune disorder that develops in 20 percent to 30 percent of people with lupus. Severe dry mouth, which can contribute to mouth ulcers, is one of the primary symptoms of Sjogren’s syndrome.

Lupus Treatment or Other Medication

Some medications commonly used to treat lupus include antimalarial drugs, corticosteroids, immunosuppressants, and nonsteroidal anti-inflammatory drugs. Almost all classes of lupus drugs have mouth ulcers as a potential side effect. In particular, it’s been shown that daily use of corticosteroids can cause mouth and nose sores.

Certain other medications, like beta blockers and nicorandil, can also cause oral issues.

Stevens-Johnson Syndrome

Stevens-Johnson syndrome, or erythema multiforme, is a rare but serious reaction to certain drugs. Besides causing painful sores in and around the mouth, Stevens-Johnson syndrome can cause fever, genital lesions, and swollen glands. This syndrome is a serious, life-threatening condition that requires immediate medical attention.

Treatments for Oral and Nasal Ulcers

Oral and nasal ulcers can be painful and may increase the risk of infection. This can be a problem for a person with lupus, whose immune system may be compromised by their illness or immunosuppressant drugs. Thankfully, there are several ways to help manage nose and mouth sores in lupus.

Before beginning treatment, your health care provider or rheumatologist may want to confirm the root cause of the lesions by performing a biopsy on your ulcers. Blood tests may also be helpful if a vitamin B12, iron, or other nutritional deficiency is to blame.

Managing Lupus

Keeping your lupus well controlled is one of the best ways to control recurrent mouth and nose sores. As part of managing your condition, you should adhere to your treatment plan, eat a healthy diet, and get plenty of exercise.

Treating Mouth and Nose Sores

Some of the remedies recommended for canker sores can also help with mouth sores from lupus. If you’re dealing with mouth and nose ulcers caused by lupus, your health care provider can suggest treatment options for you. These remedies might include:

  • A medicated mouthwash
  • Topical creams or gels, such as triamcinolone dental paste
  • Steroid nasal sprays or topical steroid pastes
  • Saltwater and baking soda rinses
  • Topical numbing gels or rinses, such as those containing benzocaine

Other Tips for Managing and Preventing Ulcers

Other ways to stay on top of your lupus progression, minimize flare-ups, and manage ulcers include:

  • Avoiding acidic or spicy foods, especially if you have active ulcers
  • Examining the inside of your mouth frequently so you can identify and treat any sores early
  • Knowing and avoiding triggers that can cause lupus flares for you specifically, such as sun exposure and certain foods
  • Maintaining good oral hygiene and visiting your dentist regularly
  • Using a soft-bristle toothbrush and nonabrasive toothpaste (with fluoride) to gently clean your teeth
  • Managing stress levels by seeing a therapist and practicing stress reduction methods

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 202,000 members come together to ask questions, give advice, and share their experiences with others who understand life with lupus.

Do you have mouth or nose sores from lupus? How do you manage them? Leave your thoughts in the comments below, or start a conversation by posting on MyLupusTeam.

Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Nyaka Mwanza has worked with large global health nonprofits focused on improving health outcomes for women and children. Learn more about her here.

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