Lupus Rash

General Information, Lupus Rash, Main Blog, Malar Rash, Photosensitivity, Symptoms

The Lupus Butterfly Rash or Malar Rash: Information You Need to Know.

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?

72dpi-Malar-Rash-with-logoDerived 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 of its butterfly-like shape.  Because this particular Malar rash is typical in those suffering from SLE (systemic lupus erythematosus), but even then in only around 40% of patients, it is the primary reason that most lupus organizations have the butterfly as their symbol.
Like at Molly’sFund Fighting Lupus, see our logo below!

Notice the butterfly in the logo!
Molly's Fund Fighting Lupus

So What Can Be Some of the Causes of a Malar, or Butterfly Rash?

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? 

Here is where it gets a touch confusing.  As we know, rashes, in general, can be caused by all sorts of things ranging from allergies, illnesses, body temperature shifts, to eczema, to changing your skin care products or laundry detergent.  So simply having a rash, even a butterfly rash is no reason to panic. Another factor that makes it difficult for a non-physician to determine what you may have is that Rosacea and the lupus butterfly rash can look very similar.  It is important to take into account any other unusual-to-your-body symptoms you may be experiencing; such as profound fatigue, painful swollen and/or stiff joints, fever, weight changes, and if you are presenting with Raynaud’s Syndrome.
The American College of Rheumatology* has created a set of criteria to assist physicians in making a diagnosis of lupus. The individual must have 4 of the 11 specific criteria to be diagnosed with lupus. It is important to remember that having some of the following symptoms does not mean that lupus is the diagnosis.
The criteria include the following:
If you are having some of these symptoms, and have concerns that you may have lupus, please visit Molly’s Fund Fighting Lupus-Referral Network  to find a qualified physician in your area.  (Rheumatologists are the type of doctors that typically treat lupus.)

So what are the differences between rosacea and malar rashes?

This is not an easy distinction to make, but these following detailed descriptions may help.  It is important that if you have any concerns about a persistent and unexplained rash, you seek medical attention from a dermatologist (a physician who specializes in the treatment of the skin) immediately.

Rosacea has three stages:

1. Pre-rosacea: You flush easily, but it goes away.
2. Vascular rosacea: You flush easily and it stays longer as the capillaries in your face stay dilated longer. Your skin may be more sensitive.
3. Inflammatory rosacea: Skin stays red; inflammation and acne-type cysts occur. In men, the nose may become enlarged and bulbous (i.e., President Clinton had rosacea!).
As rosacea is caused by inflammation and is easily irritated, it may indeed feel hot. Never apply moisturizer to rosacea to try to calm it unless it’s a dermatologist-recommended moisturizer. Rosacea can be treated with prescription topical medications that also contain moisturizer.  Rosacea rarely clears up on its own and has a tendency to worsen with time so, again, please see a medical professional for any unexplained persistent rash or irritation.

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 lupusLupus Rash Picture (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.Lupus Rash Pictureb. 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.Discoid Lupus Picture


3.  Chronic cutaneous lupus (also called DLE, discoid lupus erythematosus): These lesions are found in only about 20% of SLE patients. Chronic discoid lupus is also found in people who have no trace of systemic lupus.  In discoid lupus patients, the lupus is confined to the skin only.  The lesions are rarely found below the chin, occurring most often on the scalp (often causing hair loss), and outer ear, and almost never on the legs.  These are usually slightly elevated red or pink areas that form flakes or a crust on the surface of the skin.  The center area will become depressed and scar over time as these lesions mature.  They may be itchy and get larger, spreading outward and then leaving a central scar.  In individuals with darker complexions, the central area can become de-pigmented; in all individuals the outer red area may become hyper-pigmented.

Discoid Lupus Rash Picture

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:

Prevention Tips?

Because these rashes attack the skin, it only makes sense to protect it from direct exposure to sunlight and even florescent light exposure.  These four main rules that minimize sun exposure can help prevent and reduce much of the discomfort that can worsen lupus rashes for those with photosensitivity.


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!

We hope this blog has been helpful and informative. If so, we welcome your comments and suggestions and encourage you to share this blog with others who may find it helpful.

*All images are property of and were created by Molly’s Fund Fighting Lupus (excluding the image from, to use one of the other images, please contact [email protected] for written permission, image credit must be given to Molly’s Fund Fighting Lupus.
**Disclaimer- We, at Molly’s Fund are not physicians, we are posting this as broadly informational only, and therefore citing the references from where we find the information.  Our goal is to hopefully make topical information more clear and concise and save you some leg work!

You have just read this blog on lupus rashes. You may now also be interested in the following blogs:

Discoid Lupus

Lupus and Photosensitivity: When the Sun is Your Enemy

Lupus Flares: Recognizing one, triggers, and prevention


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Article by : Karrie Sundbom

Karrie is the Digital Marketing Manager at Molly's Fund and responsible for innovating content for all of Molly's Funds online communications, creating memes and graphics, writing the MFFL Newsletter and main lupus blogs, as well as developing and managing the content for all of our social media platforms. Connect with Karrie on LinkedIn and Google+ .
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