Lupus Nose Sores: Causes, Symptoms and Treatment
It’s easy to forget how often your nose is used throughout the day — unless it becomes compromised by something, such as a sore or ulcer. Then you are suddenly aware of every painful sniff, sneeze or breath. An irritating lupus nose sore will send you looking for treatment options straightaway.
Nearly half of people with systemic lupus will develop mucosal ulcers in their mouth or nose. In fact, having mouth or nose ulcers is one of the 11 diagnostic criteria for lupus from the American College of Rheumatology. The medical research on ulcers is sparse and primarily focused on mouth sores, but it’s just as important to recognize and treat nose sores.
What Are Lupus Nose Sores?
A sore is a spot where there has been a break in the skin or mucosal lining, which means the skin has eroded and left the tissue underneath exposed. Lupus nose sores happen most commonly on the inside center wall of the nose; this is likely because the septum has a lot of sensitive blood vessels that can easily become irritated. Although it is rarer, sores can also appear on the exterior skin of the nose.
These sores can be a warning sign of a lupus flare. Some people can feel the sores starting to form and if they don’t take quick action, the sores erupt. Unfortunately, these sores tend to take longer to resolve than other symptoms — possibly sticking around for weeks after the flare is over.
Lupus nose sores are not necessarily painful, but many people report that they are uncomfortable or cause stinging or burning pain. Most people with lupus say that their sores tend to have favorite spots.
What Causes Them?
Since nose sores tend to occur alongside flares, any of the standard lupus flare triggers can cause them. This includes things like too much UV light exposure, stress, hormonal changes, vitamin deficiencies or exhaustion. Dry air exposure is also a common trigger for many people.
People with discoid lupus are particularly prone to nose ulcers, as skin involvement is the primary manifestation of discoid lupus.
However, nose sores can occur as a side effect of medication or from a different condition altogether. If your nose sores don’t typically coincide with other lupus symptoms, then you may want to check to see if there is a cause other than lupus.
Sjogren's syndrome can cause dryness throughout the body (which may contribute to the development of nose sores) and is widely found among lupus patients. Ask your doctor to test for Sjogren's if you experience significant dryness, especially in your eyes and mouth.
Symptoms and Treatment
A painful lupus nose sore will be quickly noticed and located. Painless sores, on the other hand, will require visual checks and regular monitoring. Some common symptoms of nose sores include:
- burning or stinging sensation
- crust developing near the nostrils
- oozing liquid, blood or mucus
- scabbing in the nose
Unlike many lupus symptoms, nose sores tend to be quite visible, which makes them easier to identify and treat locally.
Standard medications for systemic lupus, such as anti-malarials, immunosuppressants or steroids, are often helpful in preventing or controlling nose sores. If they are not enough, however, more specific treatments for nose sores include:
- steroid cream, rinses or sprays — though keep in mind these should be used sparingly because they can thin the skin over time, which could cause issues with future sores
- antihistamine topical or oral treatment has helped with some mucosal ulcers — this is likely because H1-antihistamines, such as Benadryl, help blood vessels narrow and slow the flow of blood in and out of the vessels
- topical anesthetics (like Orajel) to help with pain
- saline spray or rinse (saline gels, such as Rhinase, are also available)
- Petroleum jelly (Vaseline) or lubricating lotions and creams
Nutritional supplements recommended by people with lupus to prevent nose sores include L-Lysine and folic acid. Some have also used antivirals to treat sores. Make sure you discuss all treatments you’re considering with your doctor.
While there is a variety of over the counter treatments and home remedies for nose sores, it’s important not to use anything that irritates your nose. Many lupus patients report that dry air exposure triggers their nose sores. Avoiding dry air or minimizing its effects can help, such as wearing a mask that covers your nose during an airline flight or using a humidifier in your home.
Some people have used red light therapy for mouth ulcers with great success, though this is still considered an experimental treatment. Red light therapy is performed by holding a small light pen against the ulcer for a short time, which may encourage the reproduction of epithelial cells that will heal over the open sore. It’s possible this treatment could also help nose ulcers to heal faster.
Lupus nose sores can become infected and then need treatment with antibiotics. There are a variety of topical antibiotics that can be used. A sore may be infected if it turns red, becomes more painful or lasts longer than three weeks.
A sore can cause other complications, such as a cyst developing underneath it. This may happen because the sore disrupts the normal functioning of pores, causing a blockage that can lead to infections or cysts. These can also be treated with antibiotics, but any cysts should be monitored and may need to be drained or even surgically removed.
Living with Lupus Nose Sores
Having uncomfortable sores in one of your airways is not a fun thing to live with, but you can find ways to treat them and cope with their presence. It may take several rounds of treatment before you find what is best for your body.
If you have sores on the outside of your nose, you may find it difficult to go out in public and you may want to see a therapist. Hopefully, as you work with your rheumatologist you can greatly minimize the appearance of lupus nose sores.