Chances are, you’ve been surprised at some point by a sudden trickle of blood from a nostril — and if you have lupus, you might have wondered if your condition is behind your nosebleeds.

In this article, we'll explore whether nosebleeds can be a symptom of lupus and discuss other possible causes of this always inconvenient, sometimes upsetting situation. We'll also provide practical tips for managing nosebleeds.

Nosebleeds Aren’t a Common Lupus Symptom

Nosebleeds are generally not considered a common symptom of lupus. Rather, nosebleeds are often caused by triggers unrelated to lupus, such as nasal dryness, allergies, or minor injuries. That said, some MyLupusTeam members have reported experiencing nosebleeds.

“A few months ago, I started having nosebleeds, especially during lupus flares. I noticed they were worse when my sinuses became dry and inflamed,” one member shared. “To address this, I placed a humidifier on my nightstand while I sleep, and it has significantly helped.”

Another member reported, “I have only had one nosebleed in my 20 years of lupus. About 17 years ago, I experienced it for the first time while taking prednisone due to a flare. I stopped the bleed and attributed it to the medication. Since then, I haven’t had any nosebleeds.”

Those experiences illustrate how nosebleeds can vary among people with lupus. Some may attribute occasional nosebleeds to lupus treatments or flare-ups, whereas others may not experience nosebleeds at all.

In this article, we’ll explore possible ways that lupus affects your risk of nosebleeds, as well as other reasons these incidents occur, even if they’re not directly related to lupus.

Nosebleeds Can Have Other Links to Lupus

Factors related to lupus could lead to nosebleeds in some people who have the condition. Inflammation-related sores, certain lupus treatments, or a low platelet count could all play a role.

Sores in Your Nose

As an autoimmune disease, lupus can cause inflammation in various parts of your body, including your nasal passages. This inflammation can lead to ulcers (sores) in your nose, making you more susceptible to nosebleeds. Sores may occur more often during lupus flares, when symptoms worsen for a period of time.

Sores are often associated with cutaneous lupus erythematosus, which affects only the skin (such as discoid lupus), but they may also occur in people with systemic lupus erythematosus (SLE), the most common type of lupus. Your doctor may prescribe a steroid to help treat sores in your nose, but the best way to prevent them is to manage your lupus.

Medications and Treatments

Certain medications that are used to treat and manage clots in lupus, such as anticoagulants and antiplatelet drugs, may have blood-thinning effects. This increases the risk of bleeding, which may lead to or worsen nosebleeds. To treat nosebleeds caused by lupus treatment, your rheumatologist may reduce your dose or take you off the medication responsible.

Low Platelet Count

Platelets are blood cells responsible for blood clotting and prevention of bleeding. In lupus, your immune system can attack and destroy platelets, leading to thrombocytopenia (low platelet count).

Some medications that are used to treat lupus, such as cholesterol-lowering statins or nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen (Aleve, Naprosyn) or ibuprofen (Motrin), can trigger thrombocytopenia. According to Hospital for Special Surgery, as many as 25 percent of people living with SLE will develop thrombocytopenia. A low platelet count can result in easy bruising and bleeding and may be a contributing factor to nosebleeds in those with lupus.

It’s important to talk with your doctor if you have persistent or worsening nosebleeds. They’ll first use a blood test called a complete blood cell count to check your platelet levels. If you have thrombocytopenia, your doctor may suggest using corticosteroids or immunosuppressive medications to help control your lupus and prevent it from attacking your platelets.

Nosebleeds Happen for Various Reasons

Many factors can set off a nosebleed, and knowing about these triggers can help you determine whether your nosebleeds are related to lupus. Common causes of nosebleeds in people with and without lupus include:

• Dry air — Dry air is a common culprit for nosebleeds, especially during cold weather or in places with low humidity. When the air lacks moisture, it can dry out the inside of your nose, making the blood vessels more fragile and prone to bleeding.
• Allergies and sinus infections — If you have allergies or a sinus infection, your nasal passages can become inflamed and congested. The swelling and irritation can make the blood vessels in your nose more likely to break and bleed.
• Physical trauma — Any injury or trauma to your nose, such as getting hit in the face or picking your nose too much, can lead to nosebleeds. The impact or pressure can cause blood vessels inside your nose to break, resulting in bleeding.
• Medications — Certain medications, such as blood thinners, can interfere with your blood’s ability to clot, making nosebleeds more likely. If you’re taking any medications, discussing the potential side effects with your health care provider is important.

You Can Take Steps To Manage Nosebleeds

You can take several steps to halt an active nosebleed. In addition, several strategies can help reduce your risk of getting nosebleeds.

Treating a Nosebleed

Dealing with a nosebleed can be a bit scary, but a simple plan can help you manage it effectively. Follow these steps to treat a nosebleed:

1. Stay calm — Nosebleeds can be alarming, but anxiety and stress can make the bleeding worse. Take a deep breath and try to remain composed.
2. Sit up and lean forward — It’s a common misconception that you should tilt your head back during a nosebleed, but that can cause blood to flow down your throat. Instead, sit up straight and lean forward slightly, which keeps you from swallowing blood and perhaps feeling sick.
3. Pinch your nose — Using your thumb and index finger, gently pinch your nostrils together for 10 to 15 minutes. The constant pressure helps the blood to clot and stops the bleeding.
4. Breathe through your mouth — Make sure you’re getting enough air so you aren’t tempted to stop pinching your nose before time is up.
5. Apply a cold compress — Wrap a cold pack or a bag of ice in a clean cloth and gently place it on the bridge of your nose. This helps shrink the blood vessels and slows the bleeding.
6. Get medical help if needed — Reach out to a health care professional if the bleeding doesn’t stop after 20 minutes or if you feel dizzy or have trouble breathing.

After your nose stops bleeding, proceed with caution. To prevent the nosebleed from coming back, don’t bend down or blow or pick your nose for several hours.

Preventing Nosebleeds

Whether or not your nosebleeds are related to lupus, you can take several measures to help prevent them:

• Keep your nose moisturized — Using a saline nasal spray or dabbing a bit of petroleum jelly inside your nose can help prevent dryness and minimize the risk of nosebleeds.
• Run a humidifier — Adding moisture to the air can help prevent dryness in your nasal passages, especially during dry seasons or in environments with low humidity.
• Stay away from irritants — Cigarette smoke, strong chemical smells, allergy triggers, and dry air can dry out your nose even more and increase the risk of nosebleeds.
• Avoid injuring your nose — Picking your nose and inserting objects into your nostrils can damage the delicate blood vessels and trigger nosebleeds.

Some Nosebleeds Warrant Medical Attention

Although most nosebleeds can be managed at home, certain factors may indicate the need for medical attention. See a health care professional if:

• The nosebleed was caused by some sort of traumatic injury, such as a car accident or hitting your head.
• The bleeding lasts longer than 30 minutes or is difficult to control.
• Heavy bleeding is accompanied by dizziness or light-headedness.
• Your nosebleeds occur more than once a week or don’t improve with home care.
• Other concerning symptoms, such as severe headaches, chest pain, or unexplained bruising, also occur.
• You have a bleeding disorder or take blood-thinning medications.

Remember, it’s always better to seek medical advice if you’re unsure or concerned about your symptoms.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 223,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Do you experience nosebleeds? Have you and your doctor discussed whether they’re related to your lupus diagnosis? Share your experience in the comments below, or start a conversation by posting on your Activities page.