Systemic Lupus Erythematosus (SLE) is a chronic condition where the immune system mistakenly attacks healthy tissues throughout the body. This autoimmune response affects various organs, including the skin and mucous membranes. Oral ulcers, often confused with common canker sores, are a frequent manifestation of SLE. These mouth sores are a common complaint among patients and often signal ongoing disease activity.
The Direct Link Between Lupus and Oral Ulcers
Oral ulcers are a recognized feature of SLE and are included in the classification criteria used to diagnose the condition. The underlying cause is the systemic inflammation characteristic of lupus. The immune system generates autoantibodies that target the body’s own cells, leading to chronic inflammation and tissue damage in the mouth lining.
This autoimmune activity results in the release of pro-inflammatory cytokines and the activation of immune cells, which directly damage the delicate mucosal tissues. The formation of these ulcers is a physical sign that the disease is active or flaring. Their appearance often correlates with increased disease activity elsewhere in the body.
The presence of oral ulcers in a patient with SLE is considered a specific sign of mucocutaneous involvement. This is distinct from sores caused by infection or trauma. The immune system’s attack on the oral lining is a direct result of the lupus pathology.
Identifying Lupus-Specific Oral Lesions
Lupus-related oral lesions exhibit specific characteristics that distinguish them from common aphthous ulcers. A key differentiator is that ulcers caused by active lupus are frequently painless or cause only minimal discomfort, contrasting with the intense pain of a typical canker sore.
These lesions often present with a distinct appearance, typically as white or silvery ulcers surrounded by redness. They may also appear as erythematous (red) areas with a white halo or fine, white, radiating lines. This visual presentation is characteristic of inflammation targeting the mucosal layer.
The location of these sores is another important clue. Lupus-specific ulcers commonly appear on the hard palate, the buccal mucosa (inside the cheeks), and the gums. Unlike common canker sores, which form on mobile tissues, lupus lesions frequently involve non-mobile tissue. Up to 74% of lupus-related mouth ulcers are found on the hard palate.
Treatment and Management of Lupus-Related Sores
The primary strategy for managing oral ulcers caused by lupus focuses on controlling the underlying systemic disease activity. Systemic treatments for lupus, such as antimalarials like hydroxychloroquine or oral corticosteroids, are often effective in reducing the frequency and severity of the lesions. When lupus disease activity is successfully suppressed, the mucosal ulcers tend to heal.
For localized relief, topical treatments are the first line of intervention. These include high-potency topical corticosteroids, such as triamcinolone dental paste, applied directly to the ulcerated area to reduce local inflammation. Medicated mouth rinses containing low-dose dexamethasone elixir may also be prescribed to bathe the oral cavity in anti-inflammatory medication.
Symptom Management
Pain management is addressed using topical anesthetics, such as lidocaine viscous solution, which can be swished before meals to temporarily numb the area. Patients can also manage symptoms with non-prescription remedies like salt water rinses to keep the area clean. Maintaining meticulous oral hygiene, using a soft-bristle toothbrush, and avoiding overly acidic or spicy foods help prevent irritation and support healing.