What is lupus?
Lupus is a widespread and chronic (lifelong) autoimmune disease that, for unknown reasons, causes the immune system to attack the body’s own tissue and organs, including the joints, kidneys, heart, lungs, brain, blood, or skin. Lupus causes a wide variety of devastating symptoms. It can affect nearly every organ in the body with no predictability, causing widespread infections and inflammation. The malar or butterfly rash (also known as acute cutaneous lupus), is the topic of this blog, is just one of the four types of lupus and is isolated to the skin.
What is a Malar or Butterfly Rash?
So What Can Be Some of the Causes of a Malar, or Butterfly Rash?
- Systemic Lupus Erythematosus (SLE): SLE is a chronic autoimmune disease that causes an attack on the cells, tissues and organs of the body. This may actually damage the organs and/or render the organs dysfunctional. The organs most often affected are the brain, heart, lungs, liver, kidneys, blood vessels, joints, the tissues and the skin and the overall nervous system. No one knows for sure what triggers SLE, but some suggested causes for lupus to present in the body are either genetics, or exposure to environmental pollutants. Both men and women can be affected with lupus, but it is predominately found in women between the child-bearing ages of 15-44, although children and elderly can also have lupus. It is also more common in women or African American, Asian, and Latino decent. The lupus butterfly rash presents itself in around 40% of lupus sufferers*.
- Bloom Syndrome: This is a kind of syndrome that causes abnormalities in the pattern of chromosomal arrangement in a person. One of its effects in the development of rashes on the epidermis including butterfly or malar rash.
- Lyme disease: This disease is mostly caused by the ticks of mice which leads to the bacterial agent, named Borrelua burgdorferi affect the eyes, heart, the nervous system, the musculoskeletal system and the skin. One of the effects on the skin can be manifested in the form of malar or butterfly rash.
- Erysipelas: Another bacterial agent named Streptococcal is responsible for causing acute inflammation of the skin causing red and painful lupus malar rashes.
- Seborrhea or Seborrheic Dermatitis: It is a chronic skin disease that just not causes the scaling of the skin and dandruff formation in the hair but also leads to the development of rashes on the skin and scalp, including malar rashes on the face, chest and neck.
- Dermatomyositis: This is a connective tissue disorder that causes skin and muscular inflammation and is one of the root causes behind malar or butterfly rash.
- Photosensitivity: Overexposure to harmful rays of the sun also causes butterfly or malar rash, especially to those who have extreme photosensitivity.
Could having the butterfly rash be a sign that you have lupus or is it something else entirely: How do I know if it’s lupus?
- Malar rash – a rash shaped like a butterfly that is usually found of the bridge of the nose and the cheeks.
- Discoid rash – a raised rash usually found on the head, arms, chest, or back.
- Sunlight sensitivity
- Mouth ulcers
- Inflammation of the joints
- Heart or lung involvement
- Kidney problems
- Seizures or other neurological problems
- Positive blood tests
- Changes in normal blood values
So what are the differences between rosacea and malar rashes?
Rosacea has three stages:
Types of lupus rashes:
Now that we have discussed and described the symptoms of rosacea rashes, here are the three types of lupus rashes in order to make contrasts and comparisons.
1. Acute cutaneous lupus (also known as the lupus butterfly rash or malar rash): As described at the beginning of this blog, the name is derived from the Latin word ‘mala’ which means cheekbone, the malar or butterfly rash is a kind of skin condition typically characterized by the appearance of rashes across the cheekbones and over the bridge of the nose. These rashes are usually red or purple in color in either a blotchy pattern or completely red over the affected area, and can be flat or raised in nature. The rash can be mild or severe but is not usually painful. It can be itchy if it is more like a rash than a blush and some patients even report a ‘hot’ feeling with more severe malar rashes. It is called the lupus butterfly rash because on the face, its shape resembles the outstretched wings of a butterfly across the nose and cheeks. Because the butterfly rash is one of the most visible and recognizable symptoms of lupus (although it only occurs in about 40% of lupus patients) many lupus organizations have the butterfly as their symbol.
2. Subacute cutaneous lupus lesions, which can be divided into two categories:
a. The first type is highly sensitive to sun exposure (called photosensitivity) and looks like red pimples as the rash begins to develop. It can also be described as a psoriasis-like lesion with red scaly patches on the arms, shoulders, neck, and trunk with fewer patches on the face. These pimples become larger and scales begin to appear as the rash persists. Patients typically complain of moderate to severe itching associated with this rash. Again, sun exposure usually worsens this rash, and it can appear on the face, chest, and arms, etc.b. The second type starts as flat lesions and get bigger as they expand outward creating a red ring-shaped lesion with a slight scale on the edges. Over time, the center of these reddened areas lightens so that eventually the rash can look like a series of circular red areas with holes in their centers. This can appear on the face, neck, chest, arms, and back. These rashes, too, are itchy and worsen with sun exposure. These rashes usually heal without scarring, but can leave a non-depressed scar or area of de-pigmentation where the rash occurred.
Seal has lupus and the scarring on his face was caused by discoid lupus.
How do I Treat My Lupus Butterfly Rash?
It is of crucial importance to consult a dermatologist for the treatment of malar rash or any other facial rashes since facial skin is usually very sensitive in nature.
Some of the prescribed medicines and/or measures are:
- Sunscreen lotions: For those whose skin is too very sensitive to the rays of the sun and are on the treatment for malar rash must apply UVA and UVB sunscreen lotions with SPF of not less than 30 in order to be protected from the harmful UV rays.
- Avoid sunlight as much as possible. Many lupus patients have photo-sensitivity.
- Steroidal creams: Application of steroidal creams prescribed by the doctor helps in reducing the inflammation involved in case of malar rash and may even provide relief from itching, should that occur. These creams may cause dilated blood vessels and should be used cautiously on the face.
- Drugs: Non-steroidal drugs which are both anti-malarial and anti-inflammatory in nature are prescribed to treat lupus malar or butterfly rash. Moreover, disease modifying anti-rheumatic drugs (DMARDs) and Immunosuppressive drugs are recommended for severe malar rash. They help in treating the disease well and also prevent the recurrence of the disease.
- Alternative home remedies for soothing skin: Besides these medications, one can also treat malar rash at home by applying vitamin E oil, olive oil, cod oil, and even a pinch of baking soda on the affected area since it reduces the irritation and pain involved. One may take a bath using oatmeal ingredients in warm water and may also apply fresh Aloe Vera gel on the affected area so to allow the fast and effective healing of the butterfly rash.
Final Note on Lupus Rash
Moral of the story, if you have a persistent and unexplained rash, get it checked out by a medical professional (a dermatologist) to get proper treatment. For those of you who have been diagnosed with lupus, are under the care of a physician already, and want to reduce the chances of developing a lupus rash and prevent lupus flares, stay out of the sun!
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*All images are property of and were created by Molly’s Fund Fighting Lupus. To use one of these images, please contact us at [email protected] for written permission; image credit and link-back must be given to Molly’s Fund Fighting Lupus.
**All resources provided by Molly’s Fund are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your medical provider with any specific questions or concerns.
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