Mouth Ulcers and Sweet’s Syndrome

Updated 31/03/17.

Does Sweet’s syndrome cause mouth ulcers?

Yes. Occasionally, Sweet’s syndrome can cause mouth ulcers (aphthous-like ulcers), but this is a symptom that is more commonly associated with the similar condition, Behcet’s syndrome.

Can Sweet’s syndrome cause other mouth problems?

Yes. On rare occasions, Sweet’s syndrome can cause other mouth problems, and also affect the throat. Reported symptoms include:

  • Cracks or fissures on the corners of the mouth (Contrucci and Martin, 2015).
  • Lesions on the inside of the lips (haemorrhagic bullae and vesicles, and necrotic nodules) (Cohen, 2007).
  • Lesions on the gums (haemorrhagic bullae and vesicles).
  • Necrotizing ulcerative periodontitis.
  • Enlargement of the gums (gingival hyperplasia) (Ibid).
  • Lesions on the tongue (aphthous-like ulcers, ulcers, and macerated papules) (Cohen, 2007; Kasirye et al, 2011: 135) .
  • Tongue pain, and swollen or enlarged tongue in association with lesions (Cohen, 2007; Contrucci and Martin, 2015; Kasirye et al, 2011: 135).
  • Lesions on the roof of the mouth (macerated papules, individual and grouped pustules, ulcers, and bullae) (Cohen, 2007; Contrucci and Martin, 2015).
  • Lesions affecting the pharynx (individual and grouped pustules) (Cohen, 2007).
  • Lesions on the inside of the cheeks (aphthous-like ulcers, and ulcers).
  • Inflammation of the saliva glands in the cheeks (parotitis) and associated cheek swelling (Jo et al, 2012).
  • Throat pain, painful swallowing, and hoarseness (Contrucci and Martin, 2015).

Read more about the symptoms of Sweet’s syndrome here.


Can mouth ulcers be treated or managed?

Yes. Mouth ulcers can be treated or managed, and the UK charity, the Behcet’s Syndrome Society, has put together a patient-information-leaflet to show you how. The information in this leaflet has been written for those with Behcet’s syndrome, but is also relevant to those with Sweet’s syndrome.

Information in the Behcet’s Syndrome Society leaflet – Behcet’s Disease and Mouth Ulcers – includes (Birmingham Centre of Excellence, 2013):

  • Treatment.
  • Relief of pain.
  • Relief of inflammation and reduction in ulceration.
  • Protective barriers.
  • Antimicrobial agents, including doxycycline (a treatment for Sweet’s syndrome).
  • Colchicine (a treatment for Sweet’s syndrome).

For people in the US with Sweet’s syndrome or other autoinflammatory conditions, lots of useful information about the symptoms of autoinflammatory conditions can be found on the Systemic Autoinflammatory Disease (SAID) Support blog.

Information about mouth ulcers from the SAID Support blog – Mouth Ulcer Treatment and Prevention – includes (Tousseau, 2013):

  • Prescription Magic mouthwash (not available in the UK).
  • Milk of Magnesia and liquid Benadryl.
  • Hydrogen Peroxide and Milk of Magnesia.
  • B vitamins (only if the mouth ulcers are caused by folic acid or B12 deficiency. In Sweet’s syndrome, the ulcers are not caused by deficiency, but a daily B vitamin may help to reduce your overall risk of developing non-Sweet’s syndrome-related mouth ulcers).

A warning about the topical anaesthetic, Benzocaine.

Benzocaine is a topical anaethestic found in some throat sprays or dental gels, and has been associated with an increased risk of seizures and the rare blood condition, methaemoglobinaemia, in young children. The National Institute for Health and Care Excellence (NICE) does not recommend the use of benzocaine or any other topical anaesthetic in children under the age of two, unless on the advice of a health professional or under medical supervision (CKS, 2014).


New research.

Anakinra.

Anakinra (Kineret) is a useful treatment in refractory (chronic or persistent, or difficult-to-treat) Sweet’s syndrome and other neutrophilic dermatosesand autoinflammation of unknown cause (Kluger et al, 2011: Simon et al, 2014). The results of a recent 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).


Further information.

Ngan, V. and Oakley, A. (2016) Aphthous Ulcers (online). Initially published in 2003, and updated by Professor A. Oakley, Jan 2016. Accessed 30/03/17.


References.

Birmingham Centre of Excellence (2013) Behcet’s Disease and Mouth Ulcers. Behcet’s Syndrome Society (PDF).

CKS: Clinical Knowledge Summaries (2014) Teething – Topical Anaesthestics. NICE: National Institute for Health and Care Excellence (online).

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 (online).

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 (online).

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).

Simon, A. et al (2014) Autoinflammation of Unknown Cause. AUTOINFLAMMATION.EU (online).

Tousseau, J. (2013) Mouth Ulcer Treatment and Prevention. SAID Support (online).

© 2012-2017 Sweet’s Syndrome UK

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