Medically Reviewed by Carol DerSarkissian, MD on September 01, 2022
What Are Oral and Nasal Ulcers?

What Are Oral and Nasal Ulcers?

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Lupus affects many parts of the body, with symptoms like joint and muscle pain, rashes, tiredness, and sun sensitivity. This autoimmune disease can also cause sores called ulcers to form on the inside of your mouth or nose. Up to 40% of people with lupus have ulcers. Sometimes these sores are the first symptom of the condition. Ulcers can be painful, and they're worth telling your dentist and doctor about because they are treatable.

What Causes Them?

What Causes Them?

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Ulcers form when the layer of skin inside your nose or mouth wears away and leaves an open wound. You're most likely to see ulcers during a lupus flare. They can appear with symptoms like joint pain and rashes. Stress and fatigue make them worse. If you get sores when you're not in a flare, they could be a reaction to an NSAID pain reliever or another medicine you take. A lack of vitamin B12 or iron might also cause them.

What Do Ulcers Look Like?

What Do Ulcers Look Like?

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Lupus mouth sores are red with a white ring around them. White lines may extend out from the sores. Ulcers can form anywhere in your mouth, but they often appear on the roof of the mouth, the lining of the cheeks, the gums, and the lips. In your nose, you'll find ulcers on the wall that separates your two nostrils, called the septum. The ulcers might be painless, or they may hurt.

Lupus Treatments

Lupus Treatments

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Treatments that target your immune system to control lupus should clear up ulcers, too. Steroids bring down inflammation and relieve pain by calming your immune cells. Rubbing a steroid cream on the sores every few hours can help them clear up more quickly. Oral steroids that work throughout your whole body may be an option if the ulcers don't respond to cream. Steroid nasal spray treats ulcers in the nose.

Anti-Malarial Drugs

Anti-Malarial Drugs

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If steroids don't make the sores go away, your doctor might recommend an oral medicine like hydroxychloroquine (Plaquenil) or chloroquine phosphate (Aralen) to clear them up. These drugs were originally designed to prevent malaria, but they also treat lupus symptoms. Anti-malarial medicines can help prevent flares and relieve other lupus symptoms like joint pain, skin rashes, and fatigue.

Pain Relievers

Pain Relievers

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Ulcers can be uncomfortable. Your doctor might prescribe a pain reliever to numb the area. Over-the-counter painkillers are available in a mouthwash, gel, or spray. Check with your doctor first to make sure the medicine you plan to buy is safe and that it won't interact with any other medicines you take. Read the package instructions carefully before using the product.

Caring for Your Mouth

Caring for Your Mouth

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Keep your mouth clean with regular brushing and flossing to prevent bacteria from getting in and causing an infection. Rinse with an antiseptic mouthwash. Let your dentist know if you have any signs of infection, like pain or bleeding from the ulcers, so you can start on antibiotics to treat it.

Avoid UV Light and Dry Lips

Avoid UV Light and Dry Lips

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Try to stay out of the sun while you have oral and nasal ulcers. Exposure to UV light is a lupus trigger that can make your symptoms worse. Keep your lips moist with petroleum jelly, a UV-protective lip balm, or another type of ointment that your doctor recommends.

Prevent Future Ulcers

Prevent Future Ulcers

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To prevent new mouth ulcers, practice good oral hygiene. Use a soft-bristled toothbrush and see your dentist for regular check-ups. Eat a well-balanced diet. Avoid hard, crunchy, spicy, and acidic foods that can make mouth sores worse. Don't chew gum. And avoid toothpaste with the foaming ingredient sodium lauryl sulphate, which can cause mouth sores to form in people who are prone to them.

Visit Your Doctor

Visit Your Doctor

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Lupus ulcers are usually harmless and clear up with treatment. If these sores last for longer than 3 weeks, or they're painful or red, make an appointment to see your doctor. These could be signs that you have an infection. Rarely, mouth ulcers can be a symptom of cancer, so they're definitely worth getting checked out.

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SOURCES: 

American Journal of Clinical Dermatology: "Oral Ulcers in Juvenile-Onset Systemic Lupus Erythematosus: A Review of the Literature."

Arthritis Research & Therapy: "The prevalence of oral mucosal lesions and related factors in systemic lupus erythematosus patients." 

CDC: "Diagnosing and Treating Lupus."

Cleveland Clinic: "Lupus (Systemic Lupus Erythematosus."

Hospital for Special Surgery: "Oral Concerns in People with Lupus."

Johns Hopkins Lupus Center: "Treating Lupus with Anti-Malarial Drugs."

Lupus Foundation of America: "Medications used to treat lupus."

Lupus UK: "April's Topic of the Month – Coping with Oral and Nasal Ulcers."

The Journal of Evidence-Based Dental Practice: "Oral manifestations of systemic autoimmune and inflammatory diseases: diagnosis and clinical management."

US San Diego Health: "Taking a Bite Out of Oral Health."