Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease where the immune system mistakenly attacks healthy tissues, causing widespread inflammation. SLE can affect many organs, including the skin, joints, kidneys, and nervous system. A frequent and distinguishing symptom of SLE is the occurrence of mouth sores, also known as oral ulcers. These lesions are listed among the classification criteria for SLE, making them a recognized manifestation of the disease. Their presence often signals increased disease activity or may be one of the first physical signs of a lupus flare.
How Lupus Manifests as Oral Lesions
Lupus-related oral ulcers are a direct result of the systemic autoimmune process attacking the mucosal lining of the mouth. These lesions present in different ways, often depending on whether the disease is actively flaring. Ulcers associated with an active flare typically appear as red, erosive areas that may have a surrounding white halo or white radiating lines, sometimes described as discoid. These lesions are commonly found on the hard palate, the inside of the cheeks (buccal mucosa), and the gums.
While many common mouth sores are intensely painful, lupus ulcers are frequently painless, though some people report discomfort during severe flares. The lesions can also be less specific, presenting simply as ill-defined, superficial ulcerations or patches of red and white discoloration. Reduced salivary flow, which affects about 75% of people with SLE, can also contribute to oral health issues. The appearance of these sores may indicate that the underlying systemic disease needs better control.
Differentiating Lupus Ulcers from Common Mouth Sores
Lupus ulcers must be distinguished from more common ailments like canker sores and cold sores. Canker sores, medically termed aphthous ulcers, are typically highly painful and develop on soft, movable tissues such as the inside of the lips or under the tongue. In contrast, lupus ulcers often favor the hard palate or the upper parts of the cheek, and they are generally painless.
Cold sores, caused by the Herpes Simplex Virus, are also distinctly different. They first present as small, painful blisters before breaking open and crusting over. Lupus lesions do not follow this blistering pattern, as their cause is autoimmune inflammation, not a viral infection. Furthermore, some oral lesions in people with lupus may be caused by a reaction to certain medications used to treat the condition. Any new or persistent mouth sore in a person with SLE warrants a medical evaluation to determine its exact cause.
Treatment and Management Strategies
The management of lupus-related mouth sores focuses on reducing local inflammation and treating the underlying systemic disease activity. For localized relief, topical treatments are the first line of defense, often involving prescription-strength corticosteroid gels or dental pastes applied directly to the lesion. Medicated mouthwashes containing ingredients like dexamethasone elixir or antimicrobial agents can also be used to reduce inflammation and prevent secondary infection.
If the oral ulcers are severe or frequent, it often signals an active lupus flare, requiring an adjustment to systemic medications. These adjustments may include increasing the dosage of oral corticosteroids or optimizing long-term treatments like antimalarial drugs. Simple home care measures can also provide relief, such as avoiding acidic, spicy, or abrasive foods that can irritate the ulcers. Maintaining excellent oral hygiene helps prevent further irritation and promotes healing.