Lupus Mouth and Nose Ulcers

Lupus is a type of autoimmune disease, in which the body’s immune system mistakenly attacks and damages healthy tissue. Lupus can affect many parts of the body and have many different symptoms. These symptoms often vary widely between people and may come and go over time.^1,2

Along with joint pain and fatigue, most people with lupus experience skin symptoms. One possible skin symptom is sores (ulcers) that occur on mucous membranes. These membranes are lubricated areas of skin that line entrances to the body. Up to 45 percent of people with lupus develop sores in these areas.^1-4

The insides of the mouth and nose are examples of mucous membranes. Many people with lupus have mouth (oral) and nose (nasal) sores. Often, mouth sores are one of the first symptoms to appear in people with lupus.⁵

What do lupus mouth ulcers look like?

People living with lupus can develop sores anywhere inside their mouths or noses, and even sometimes in their eyes. The sores might:^3,6,7,8

• Look like canker sores
• Have a white center surrounded by redness
• Have a red center surrounded by white lines

In people with lupus, mouth sores most often occur on the roof of the mouth or the inside of the cheeks or lips. Nose sores usually occur on the septum. This is the rigid part of the nose that divides the left and right nostrils.^4,6,8

What causes mouth and nose ulcers with lupus?

Many people get sores in their mouths at some point. These sores can have a variety of causes, including stress, hormone changes, vitamin deficiency, and drugs to treat lupus or other conditions. They are usually painless, but depending on location, they may be uncomfortable if irritated by things like spicy foods. Most people with lupus experience sores in the mouth.^5-8

Plus, people with lupus can develop mouth or nose sores that are linked to a disease flare. Sores linked to a lupus flare typically have a red center with a white border and white lines fanning out from the center. They may be painful in some people.^6,8

Your doctor may conduct an oral soft tissue exam to check for mouth sores. A biopsy can help your doctor determine whether any mouth sores are linked to active disease.^6,8

In some cases, medicines used to treat lupus can cause mouth and nose sores. If you begin to have sores right after starting a new prescription or over-the-counter medicine, ask your doctor whether the new drug may be causing them.⁸

How are mouth and nose ulcers treated?

The goal of lupus treatment is to manage symptoms as well as possible. To help relieve discomfort caused by mouth sores, you can try the following at home:⁷

• Avoid hot (in temperature) or spicy foods and drinks
• Gargle with salt water
• Apply ice to the sore
• Take over-the-counter pain relievers like Tylenol or ibuprofen

To help control chronic or severe sores, your doctor also may prescribe:^1,3,4,6

• Topical steroids, such as prednisolone, in the form of a cream, mouthwash, or dental paste
• Injected steroid drugs (corticosteroids), such as prednisone

If steroids are not effective, your doctor may prescribe stronger drugs, for example:^1,4,6

• Antimalarial drugs, such as hydroxychloroquine
• Drugs that lower your body’s immune response, such as azathioprine
• Rituximab, a cancer drug

Can lupus mouth and nose ulcers be prevented?

Your doctor can advise you on the best way to prevent mouth and nose sores in your specific case. You can help prevent sores that are not caused by lupus by:⁷

• Using stress-relief methods like yoga or meditation
• Getting more folate and vitamin B12 through your diet or supplements
• If your doctor recommends it, stopping a drug that is causing the sores as a side effect

It is also very important to get regular dental checkups. Because mouth sores often do not cause pain, you may have them without knowing it. Your dentist can see these sores during your routine exam. They can then refer you to another doctor to be assessed for lupus or other conditions.⁸