Mouth Ulcers and Sweet’s Syndrome

Updated 27/10/19.

Does Sweet’s syndrome cause mouth ulcers?

Yes, Sweet’s syndrome, otherwise known as acute febrile neutrophilic dermatosis, can cause mouth ulcers (aphthous-like ulcers). However, this is a symptom that’s more commonly associated with the similar condition and neutrophilic dermatosis, Behcet’s syndrome. Aphthous ulcers form on the mucous membranes and are normally round or oval in shape.

Can Sweet’s syndrome cause other oral problems?

Yes, as well as aphthous-like ulcers, Sweet’s syndrome can cause other types of oral lesion, e.g. papules, pustules and bullae, and affect areas such as the throat. Please keep in mind that many of these symptoms aren’t common, but include:

• Cracks or fissures on the corners of the mouth (Cohen, 2007; Contrucci and Martin, 2015; Jo et al, 2012; Kasirye et al, 2011: 135).
• Lesions on the inside of the lips, on the gums, on the tongue, on the roof of the mouth.
• Tongue pain, and swollen or enlarged tongue in association with lesions.
• Ulcers on the inside of the cheeks, and inflammation of the saliva glands and associated cheek swelling.
• Lesions affecting the throat, and throat pain, painful swallowing, and hoarseness.

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Can mouth ulcers be treated or managed?

Yes, mouth ulcers can be treated or managed, and the charity Behcet’s UK has put together a patient-information-leaflet to show you how (see ‘About Behcet’s: Behcet’s Medical Factsheets’). The information in this leaflet has been written for those with Behcet’s syndrome, but is also relevant to Sweet’s syndrome.

14. Behcet’s and Mouth Ulcers 2018. Includes:

• Relief of pain, e.g. Difflam mouthwash or spray.
• Relief of inflammation and reduction in ulceration, e.g. steroid buccal tablets, inhaler, or mouthwash (the steroid, betamethasone 500 micrograms, dissolved in 10-15 ml warm water).
• Protective barriers, e.g. carmellose sodium (Orabase), or Gelclair.
• Antimicrobial agents, e.g. chlorhexidine mouthwash, gel or spray; doxycycline (a tetracycline and treatment for Sweet’s syndrome).
• Other, e.g. colchicine (a treatment for Sweet’s syndrome).

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Information about mouth ulcers and autoinflammatory conditions can be found on the Systemic Autoinflammatory Disease (SAID) Support blog (US-based non-profit). Mouth Ulcer Treatment and Prevention (Tousseau, 2013). Includes:

• Prescription Magic mouthwash.
• Milk of Magnesia and liquid Benadryl.
• Hydrogen Peroxide and Milk of Magnesia.
• B vitamins (if mouth ulcers are caused by folic acid or B12 deficiency).

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Research.

Anakinra.

Anakinra (Kineret) is a useful biologic treatment in persistent Sweet’s syndrome, but is normally only used when most other treatments have failed. The results of a trial have shown that anakinra at an optimal dose of 200mg daily is partially effective in the treatment of resistant oral and genital ulcers in Behcet’s syndrome (Grayson et al, 2017).

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References.

Cohen, P. (2007) Extracutaneous Manifestations: Table 4. In Sweet’s syndrome – a comprehensive review of an acute febrile neutrophilic dermatosis, Orphanet Journal of Rare Diseases (BMC).

Contrucci, R. and Martin, D. (2015) Sweet syndrome: A case report and review of the literature. ENT Journal, July;94(7):282-284 (online). Sign-up to the ENT Journal for free to access the full article.

Grayson, P. Yazici, Y., Merideth, M., Sen, H., Davis, M., Novakovich, E., Joyal, E., Goldbach-Mansky, R. and Sibley, C. (2017) Treatment of mucocutaneous manifestations in Behçet’s disease with anakinra: a pilot open-label study. Arthritis Research & Therapy, Mar 24;19(1):69 (PMC).

Jo, M., Lim, Y., Shin, H., Choe, J., Seul, J. and Jang T. (2012) A Case Report of Sweet’s Syndrome with Parotitis. Archives of Plastic Surgery, Jan;39(1):59-62 (online).

Kasirye, Y., Danhof, R., Epperla, N. and Garcia-Montilla, R. (2011) Sweet’s Syndrome: One Disease, Multiple Faces. Clinical Medicine & Research, Nov;9(3-4):134-136 (online).

Kluger, N., Gil-Bistes, D., Guillot, B. and Bessis, D. (2011) Efficacy of anti-interleukin-1 receptor antagonist anakinra (Kineret®) in a case of refractory Sweet’s syndrome. Dermatology (Basel, Switzerland), May;222(2):123-7 (PubMed).

2012-present, Sweet’s Syndrome UK