Butterfly Rash
A butterfly rash, also called a malar rash, is a red or purplish skin pattern that spreads across the cheeks and bridge of the nose. Several conditions can cause it, most commonly lupus, but also rosacea, skin reactions, or sun exposure. Its shape looks like a butterfly’s wings, which is how it gets its name.
This rash may develop suddenly or gradually, and its appearance can vary from blotchy to solid in color. Some causes involve immune system activity, while others are linked to environmental triggers or skin sensitivity. Knowing what triggers it helps find the right treatment and prevent flare-ups.
Definition of Symptom
A butterfly rash, also called a malar rash, is a type of facial rash that appears across the cheeks and the bridge of the nose. Its shape looks like a butterfly, which is how it gets its name. This skin condition is usually red or purplish. It can be flat or slightly raised, and sometimes it may feel warm or tender to the touch.
The rash often appears as part of an inflammatory skin condition. It is most commonly linked to lupus rash, but it can also occur with other health issues such as rosacea or dermatomyositis. Typical malar rash symptoms include:
- Redness across both cheeks.
- Rash sparing the folds around the nose (nasolabial folds).
- Possible scaling or slight swelling.
- Discomfort or mild itching in some cases.
| Feature | Description |
|---|---|
| Location | Cheeks and bridge of nose |
| Color | Red or purplish |
| Texture | Flat or raised |
| Common Cause | Lupus and other autoimmune disorders |
The rash can last for a short time or persist, depending on the underlying cause. Sun exposure often makes it more noticeable or triggers new flare-ups. Dermatologists and other healthcare providers can examine the rash and decide if it relates to lupus or another skin rash condition.
Possible Causes/Disease Conditions
A butterfly rash, also called a malar rash, appears across the cheeks and bridge of the nose. Several medical conditions can cause it, some mild and others more serious.
- Systemic lupus erythematosus (SLE) is one of the most common causes. This autoimmune disease can trigger skin inflammation, especially after sun exposure. The rash in lupus often spares the folds around the nose.
- Rosacea can also produce redness across the cheeks and nose. Unlike lupus, rosacea often includes visible blood vessels and may cause flushing or bumps.
- Cellulitis and erysipelas are bacterial skin infections that can cause redness and swelling in the same area. These usually develop quickly and may be painful or warm to the touch.
- Dermatomyositis, another autoimmune disease, can cause a reddish or violet rash on the face along with muscle weakness.
- Pellagra, caused by niacin (vitamin B3) deficiency, may lead to skin changes on sun-exposed areas, including the face.
| Condition | Type | Common Features |
|---|---|---|
| Lupus (SLE) | Autoimmune | Red, flat or raised rash, spares nasal folds |
| Rosacea | Chronic skin disorder | Redness, visible vessels, bumps |
| Cellulitis | Bacterial infection | Swelling, warmth, pain |
| Erysipelas | Bacterial infection | Raised, sharply defined rash |
| Dermatomyositis | Autoimmune | Reddish/violet rash, muscle weakness |
| Pellagra | Nutritional deficiency | Rash on sun-exposed skin, diarrhea, confusion |
Some causes involve the immune system, while others result from infection or vitamin deficiency.
Other Non-Disease Causes
A butterfly rash can appear for reasons other than chronic illness. Some people get it after prolonged sun exposure, especially if they have sensitive skin or a history of photosensitivity.
- Photosensitivity means the skin reacts more strongly to sunlight or certain artificial light sources. This can cause redness across the cheeks and nose, sometimes looking like a butterfly rash.
- Mild skin infections can also cause redness in the same facial pattern. For example, irritation from bacteria or fungi may trigger inflammation that spreads across both cheeks and over the nose bridge.
- Certain cosmetic or skincare reactions may cause temporary rashes. Fragrances, preservatives, or harsh cleansers can irritate the skin, especially after sun exposure.
| Possible Non-Disease Cause | Common Triggers |
|---|---|
| Sun exposure | Midday UV rays, tanning beds |
| Photosensitivity | Medications, light sensitivity |
| Skin infection | Bacteria, fungi |
| Cosmetic reaction | Harsh products, allergens |
Heat, wind, or extreme cold can also irritate facial skin and cause redness in a butterfly pattern. These environmental factors often fade once the skin recovers and the trigger is removed.
How It Causes the Symptom
The immune system can react in an abnormal way and cause a butterfly rash. In autoimmune conditions like lupus, the body’s defense system attacks healthy skin cells, leading to inflammation and redness across the cheeks and nose.
This reaction, called an autoimmune response, can damage small blood vessels in the skin and cause visible discoloration. Sun exposure can make this process worse by triggering more inflammation. Doctors may order tests, such as the erythrocyte sedimentation rate (ESR), to check for inflammation in the body.
A high ESR can suggest an active immune response that might be linked to the rash. The rash forms because inflamed skin cells release chemicals that widen blood vessels and increase blood flow. This creates the red or purplish “butterfly” pattern across the face.
Possible Complications
A butterfly rash itself may not cause lasting harm, but it can be linked to underlying conditions that affect other parts of the body. These conditions can lead to symptoms beyond the skin. Fatigue is common, especially when the rash is related to autoimmune disorders such as lupus. This tiredness can affect daily activities and may persist even with rest.
Joint pain often appears alongside the rash in certain conditions. The pain may be mild or severe and can move between different joints over time. In some cases, inflammation may extend to internal organs. This can involve the kidneys, heart, or lungs, depending on the cause of the rash.
| Possible Complication | Related Symptoms |
|---|---|
| Persistent fatigue | Low energy, weakness |
| Joint inflammation | Swelling, stiffness |
| Organ involvement | Shortness of breath, chest pain, swelling in legs |
| Skin changes | Scarring, pigmentation changes |
Some people may develop photosensitivity, where sunlight worsens the rash or triggers other symptoms.
When to Seek Medical Attention
A butterfly rash can signal several conditions, including lupus, rosacea, and certain infections. Seek prompt medical care if the rash appears suddenly, spreads quickly, or comes with other symptoms. Warning signs to watch for include:
- Persistent fever
- Joint pain or stiffness
- Fatigue or weakness
- Swelling in the face or joints
If these symptoms occur, a healthcare provider will check your skin and look for other signs of illness. They may ask about your medical history and any recent changes in your health. A dermatologist may take a small skin sample to examine under a microscope. This can help confirm or rule out conditions such as lupus.
If lupus is suspected, the provider may order blood tests to check for specific antibodies. These results, along with what they find on your skin, help guide treatment. Seek immediate care if the rash is painful, blistering, or spreading rapidly. Quick evaluation can help prevent complications and lead to earlier treatment.
