Dry Mucous Membranes (Mouth, Nose, Eyes, Vaginal Tissue)
Dry mouth, also called xerostomia, may be caused by medications or may be due to an autoimmune condition called Sjogren's. Sjogren's can co-exist with lupus in about 20% of patients with lupus. Sjogren's causes inflammation in the glands that reduces lubrication and causes dryness. Dryness can affect the eyes, nose, mouth, vaginal mucosa and skin. This can cause the sensation of grittiness, dryness, irritation, redness, and sometimes itching.
General dryness tips:
- Drink water - try to take small sips throughout the day.
- Use a humidifier, particularly at night. The optimal humidity is between 55-60%. You can use a humidistat to track humidity levels in your home.
- Avoid hot water when bathing and use soap only in areas that need it (usually just feet, private areas and underarms) to avoid disrupting skin barriers. Apply a cream or ointment - moisturizer as soon as possible. Many lotions have high water contents which can evaporate more quickly and may actually be counterproductive.
- Review your medication list with your doctor to avoid drying side effects, if possible. Avoid over-the-counter medications that cause dryness, such as antihistamines (such as Benadryl).
Tips for dry mouth and nose:
- Use a fluoride rinse at least three times a day. Avoid mouthwashes that contain alcohol or witch hazel which can burn and worsen dryness.
- Brush and floss after breakfast and before bedtime
- Use lozenges or gum with xylitol to help avoid dental decay
- Avoid highly salty, acidic, spicy foods or carbonated beverages that may irritate your mouth
- Take small bites and chew fully. Always have water available while you eat.
- Use nasal sprays and gels to moisturize and clean your nose.
- Quit smoking and avoid areas with smoke.
Tips for dry eyes:
- Use preservative free artificial tears. Use them frequently, even when your eyes feel ok. Keeping them stored in the refrigerator may add extra relief.
- Use ointments or gels at bedtime to keep the eye moisturized overnight. Start by applying to the eyelids and lashes. If this does not provide relief, use ¼ inch ointment inside the lower eyelids. These are thick and may blur your vision, so take care if you get out of bed during the night.
- Try warm compresses, eyelid message, and lid hygiene to help prevent inflammation of the eyelid, known as blepharitis. Make warm compresses by wetting a washcloth with warm water then ringing out the excess water. You may also use a microwavable mask, but take care it does not get overheated. Use it for 5 minutes at bedtime and in the morning to help stimulate gland secretion in the eyelids.
- Avoid fans blowing directly on you.
- Avoid wearing products around the eye that may irritate the surrounding tissues or eye surface.
- Dry eyes may be more susceptible to developing environmental allergies. Consider an over-the-counter allergy eye drop.
- Moisture chamber glasses, goggles, or wrap around glasses may reduce air current to lessen drying.
- Take breaks every 10-15 minutes when reading or looking at a screen to rest your eyes.-
Some people with lupus experience oral and nasal ulcers, which may not always be painful. Oral sores may be from lupus inflammation, infection (such as herpes simplex virus that cause cancer and cold sores), trauma, or medication side effect (methotrexate is one common culprit).
Seeing a Doctor for Dryness and Oral Sores
Your doctor will examine your eyes and mouth which may include a test to measure tear production or salivary pooling. They may perform blood work to test for the presence of antibodies related to Sjogren's. Bring a list of your current medications and supplements to learn if a drug side effect may be contributing to your symptoms.
For eye dryness, see an eye doctor once per year or more often depending on the severity of your symptoms.
For mouth dryness: See a dentist at least two times a year. Seeing a dentist regularly will help prevent periodontal disease. This is important for people with lupus because research is beginning to show a strong link between inflammation of the gum area and overall health of the body.
For oral sores: If a sore has been present in the same spot for more than a month, you should show this to your dentist or doctor. A culture or tissue sample may need to be taken to decide the cause.