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. Lupus commonly causes mouth ulcers, which are recognized as a frequent manifestation of the disease. These oral lesions often indicate underlying disease activity or a flare.
The Direct Link Between Lupus and Oral Ulcers
The connection between SLE and oral lesions stems directly from the autoimmune nature of the condition. In lupus, the immune system targets the body’s own cells, and this immune response extends to the mucous membranes lining the mouth and nose. This sustained inflammation leads to the breakdown of the oral lining, which results in the formation of ulcers.
Oral lesions are a characteristic clinical feature of SLE and are included in the classification criteria used for diagnosis. Research indicates that 40% to over 50% of people with SLE experience these oral symptoms. The appearance of these ulcers often coincides with increased systemic disease activity, signaling a potential flare-up.
Controlling the underlying systemic inflammation is the primary mechanism for resolving oral ulcers. The presence of these lesions helps clinicians evaluate the degree of disease activity, particularly when they occur alongside symptoms such as arthritis or skin rashes. For some individuals, these sores can be one of the earliest signs leading to a lupus diagnosis.
Distinct Characteristics of Lupus-Related Ulcers
Lupus-related oral ulcers possess features that distinguish them from common mouth sores, such as canker sores. These lesions tend to appear in specific areas, most commonly on the hard palate, the inside of the cheeks (buccal mucosa), and the lower lip. The concentration of ulcers on the roof of the mouth is a notable feature of lupus lesions.
When observed, the ulcers may appear as red areas with white borders, or as white, silvery patches surrounded by a reddish halo. A key difference from typical canker sores is that lupus ulcers are frequently reported as painless or causing only minimal discomfort. This lack of significant pain is one reason they can go unnoticed, especially when located on the hard palate.
While textbooks often describe them as painless, patient surveys show that a significant portion of individuals with lupus report painful episodes. These lesions are also chronic and recurrent, tending to appear in crops or clusters during periods of active systemic disease. Understanding these characteristics is important for differentiating lupus manifestations from other oral conditions.
Strategies for Managing Oral Symptoms
Management of lupus-related oral ulcers relies on a two-pronged approach addressing local symptoms and underlying systemic disease activity. Since the ulcers are a manifestation of lupus, controlling the disease with systemic medications is the most effective long-term strategy. Drugs like antimalarials (e.g., hydroxychloroquine) and immunosuppressants reduce the body’s overall inflammatory response, helping to heal and prevent oral lesions.
For immediate relief and local treatment, topical medications are prescribed to accelerate healing and manage discomfort. High-potency topical corticosteroids, such as gels, pastes, or medicated mouth rinses like dexamethasone, are first-line treatments for localized ulcers. These medications reduce inflammation directly at the site of the lesion.
Medicated mouthwashes containing antiseptics or pain-relieving agents like benzydamine hydrochloride can soothe the mouth and prevent secondary infection. When ulcers are painful, topical anesthetics like viscous lidocaine may be applied to temporarily numb the area, allowing for easier eating and speaking. Simple supportive measures, such as avoiding acidic, spicy, or abrasive foods and maintaining excellent oral hygiene, also minimize irritation and promote healing.