Mouth sores and nose sores — often called ulcers — are common symptoms of systemic lupus erythematosus (SLE), the most frequently diagnosed type of lupus. These ulcers are typically painless, though some people with lupus may experience pain, especially during disease flares — periods when the disease is active and the symptoms are worse or more noticeable than usual. They can affect your quality of life by making it harder to talk, eat, or drink.

“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?

Mouth and nose sores may be a sign of SLE and may help lead to an initial diagnosis. Oral and nasal ulcers are also a common sign of lupus flares. In fact, studies suggest that people with SLE are at greater risk of these ulcers the longer they’ve had lupus and if they experience oral hygiene problems.

Lupus-related ulcers in the mouth can feel similar to canker sores, though they are often painless. However, in some cases — particularly during flares — they may range from mildly uncomfortable to very painful if untreated.

“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.”

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 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, injury, or nutritional deficiencies.

Active Lupus

Between 8 percent and 45 percent of people with SLE experience mouth and nose sores. These 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.

“Autoimmune diseases can cause mouth ulcers, and about one-third of people with lupus have at least one other autoimmune disease.”

Other Autoimmune Diseases

Many other autoimmune diseases may also cause mouth ulcers. A survey by the Lupus Foundation of America found that one-third of people with lupus have at least one other autoimmune disease. Inflammatory autoimmune diseases that may cause mouth sores include Behcet’s disease, celiac disease, and ulcerative colitis. Sjögren’s syndrome, an autoimmune disorder that develops in 20 percent to 30 percent of people with lupus, often causes dry mouth. This dryness can cause mouth ulcers, making Sjögren’s syndrome a common cause of oral symptoms in people with lupus.

Lupus Treatments and Other Medications

Medications commonly used to manage lupus — such as antimalarial drugs, corticosteroids, immunosuppressants, and nonsteroidal anti-inflammatory drugs (NSAIDs) — may have mouth ulcers as a side effect.

Other medications, like calcium channel blockers (used for blood pressure) and cholesterol-lowering medications, can also cause oral issues.

Stevens-Johnson Syndrome

Stevens-Johnson syndrome (SJS) is a rare but serious reaction to certain drugs, including medications used to treat lupus. This condition can cause painful sores in and around the mouth, as well as fever, genital lesions, and swollen glands. SJS is a medical emergency that requires immediate treatment.

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 someone with SLE, whose immune system may be compromised by their illness or immunosuppressant drugs. Fortunately, there are several ways to help manage nose and mouth sores in lupus.

Before beginning treatment, your healthcare provider or rheumatologist may want to confirm the root cause of the lesions. This might involve a biopsy (taking a small tissue sample to examine under a microscope) to rule out other conditions. Blood tests can also help check for vitamin deficiencies, like low vitamin B12 or iron, which might contribute to ulcers.

Managing Lupus

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

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

“To treat a mouth or nose sore, your doctor may suggest medicated mouthwash, steroid nasal spray, topical steroid paste, or a topical numbing gel or rinse.”

Treating Mouth and Nose Sores

Some remedies recommended for canker sores can also help with mouth sores from lupus. If you have mouth and nose ulcers caused by lupus, your healthcare provider can suggest treatment options. These remedies might include:

• A medicated mouthwash to reduce bacteria and inflammation
• Steroid nasal sprays or topical steroid pastes to ease inflammation and speed healing
• Topical numbing gels or rinses, such as those containing benzocaine, to reduce pain

Tips for Managing and Preventing Ulcers

To help stay ahead of mouth and nose ulcers and reduce lupus flare-ups, consider these strategies:

• Identify and avoid your personal lupus triggers, like sun exposure or certain foods.
• Quit smoking, as it can worsen ulcers and inflammation.
• Manage stress by seeing a therapist, meditating, or practicing relaxation techniques.
• Avoid acidic or spicy foods when you have active ulcers to prevent irritation.
• Check the inside of your mouth regularly so you can treat any sores early.
• Maintain good oral hygiene, including regular visits to your dentist.
• Use a soft-bristle toothbrush and nonabrasive toothpaste (with fluoride) to clean your teeth gently.
• Talk to your doctor about whether any of your medications might be contributing to ulcers.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 233,000 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 your Activities page.