From the Guidelines
Lupus patients with oral ulcers should start with topical treatments like triamcinolone dental paste (0.1%) or dexamethasone elixir (0.5mg/5mL) for pain management and to reduce inflammation, as recommended by the most recent guidelines 1. The symptoms of oral ulcers associated with Systemic Lupus Erythematosus (SLE) typically include painful ulcers on the lips, gums, palate, or inside the cheeks.
- Topical treatments are the first line of treatment for oral ulcers, and may include triamcinolone dental paste (0.1%) applied directly to the ulcers 2-3 times daily after meals, or dexamethasone elixir (0.5mg/5mL) used as a mouth rinse for 2 minutes then spit out, 3-4 times daily.
- For pain relief, lidocaine viscous solution (2%) can be swished in the mouth before meals.
- Over-the-counter options include benzocaine gels like Orajel or salt water rinses (1/2 teaspoon salt in 8 ounces warm water).
- For severe or persistent sores, prescription medications that address the underlying lupus inflammation may be necessary, such as hydroxychloroquine, corticosteroids, or immunosuppressants, as suggested by the EULAR recommendations for the management of SLE 1.
- Maintaining good oral hygiene, avoiding spicy or acidic foods, using a soft toothbrush, and staying hydrated can help prevent irritation and promote healing.
- It is essential to contact a healthcare provider if sores persist beyond two weeks, worsen, or are accompanied by fever or difficulty eating or drinking. The treatment of oral ulcers in SLE patients should be tailored to the individual patient's needs, taking into account the severity of the ulcers and the patient's overall health status, as recommended by the EULAR guidelines 1.
- The EULAR guidelines also recommend that treatment should aim at remission or low disease activity and prevention of flares, and that hydroxychloroquine is recommended for all patients with SLE, unless contraindicated, at a dose not exceeding 5 mg/kg real body weight 1.
- In cases of severe or persistent oral ulcers, the addition of immunomodulating/immunosuppressive agents such as methotrexate, azathioprine, or mycophenolate may be considered, as suggested by the EULAR recommendations 1.
From the Research
Symptoms of Oral Ulcers (Mouth Sores) Associated with Systemic Lupus Erythematosus (SLE)
- Oral ulcers or mouth sores are a common symptom of SLE, affecting the mucous membranes 2
- These ulcers can be painful and may affect a person's ability to eat, drink, or speak
Treatment Options for Oral Ulcers (Mouth Sores) Associated with SLE
- Topical corticosteroids and topical calcineurin inhibitors are first-line treatments for localized lesions 3, 4, 5
- Antimalarials are recommended as first-line and long-term systemic treatment for severe and/or widespread skin lesions 3, 4
- Systemic corticosteroids are recommended as first-line treatment in highly active and/or severe cases 4
- Second- and third-line systemic treatments include methotrexate, retinoids, dapsone, and mycophenolate mofetil or mycophenolate acid 3, 4
- Thalidomide should only be used in selected therapy-refractory cases, preferably in addition to antimalarials 3, 4