Butterfly (Malar) Rash

What is a butterfly rash (malar rash)?

A butterfly rash, or malar rash, is a facial rash that spreads from one cheek, across the bridge of your nose, to the other cheek. The rash can be itchy and painful with a burning sensation. 

This rash can stay in one spot or spread to other areas of your face. It doesn’t usually affect the nasolabial folds (laugh lines) that extend from the sides of your nose to your mouth. In rare cases, the rash may appear on your forehead and chin.

A malar rash is a common symptom of lupus, but it can happen with other conditions. A healthcare provider or dermatologist can help you determine what’s causing the rash and offer treatment options to manage it.

What does a butterfly rash look like?

A malar rash is a patch of skin with discoloration and texture differences. It often has the shape of a butterfly — that’s where it gets its name. On light skin tones, the rash may look red or pink. On dark skin tones, the rash may look brown, black or purple. It may be flat, raised or scaly.

What causes a butterfly rash (malar rash)?

A butterfly rash is often an autoimmune response. Your immune system keeps your body healthy by defending it against bacteria, viruses and other harmful invaders. Sometimes, your immune system mistakes healthy cells in your body for a potential threat. As a result, your immune system sends out its first responders to create inflammation in your skin. You can see inflammation in action as a rash. 

How is a butterfly rash diagnosed?

If you develop a rash with an unknown cause, you may want to see a primary care physician (PCP). They’ll ask you questions about your medical history and offer a physical exam. Your provider will learn more about what symptoms you experience and order testing if necessary. This could include blood or urine (pee) tests or a skin biopsy, among others.

Your provider may refer you to see a dermatologist, who is a medical doctor trained in diagnosing and treating skin conditions.

Butterfly rash and lupus connection

A malar rash is a common symptom of lupus. The rash is one clue providers use to diagnose lupus.

You may experience this rash with the following lupus types:

• Cutaneous lupus erythematosus (acute cutaneous lupus erythematosus)
• Discoid lupus
• Subacute cutaneous lupus
• Systemic lupus erythematosus (SLE)

Can a butterfly rash be something other than lupus?

Yes, lupus isn’t the only condition that causes a butterfly rash. Other conditions that cause a butterfly rash may include:

• Cellulitis (a bacterial infection in the subcutaneous fat and dermis skin layers)
• Dermatomyositis (a rare condition that causes muscle weakness and skin rashes)
• Erysipelas (a bacterial infection of the upper layers of skin)
• Pellagra (a condition caused by a lack of niacin or vitamin B3)
• Rosacea (an inflammatory skin condition)

Can the butterfly rash (malar rash) come and go?

Yes. A butterfly rash can flare up or happen suddenly when you contact certain things in your environment.

A common example is exposure to ultraviolet light from the sun or artificial light sources. If you have lupus or rosacea, light exposure can trigger or worsen malar rash symptoms. Immune cells in your skin may react to light sources by releasing chemicals that inflame your skin. This reaction is known as photosensitivity.

Triggers vary from person to person. A healthcare provider can help you determine what could be causing the rash to flare up. They’ll suggest ways to prevent it from recurring.

How do you treat a butterfly rash?

Malar rash treatments vary depending on the cause. They may include:

• Antibiotics for rosacea, cellulitis and erysipelas
• Topical corticosteroid creams, antimalarial medications and immunosuppressants for lupus and dermatomyositis
• Oral niacin for pellagra

In some cases, your skin will return to its natural tone after the rash goes away. But you may notice some skin discoloration after the rash is gone. These may be permanent. A healthcare provider or a dermatologist can help you manage these changes to your skin if they happen.

How can you prevent a butterfly rash?

You can’t prevent all causes of a butterfly rash. But you can try to avoid the triggers if you know what’s caused a flare-up in the past. For example, you can wear sunscreen and protective clothing and accessories when you go outdoors to prevent sun exposure if you have photosensitive skin.

Your provider may have suggestions to prevent symptom flare-ups specific to you and your body’s needs.

How long do butterfly rashes last?

Depending on the cause of the rash, it may fade in a few days with treatment. Sometimes, it takes several weeks for the rash to disappear and your skin to heal. Your healthcare provider can give you the most accurate information on what you can expect. For best results, follow your treatment instructions as directed.

Keep in mind that some butterfly rash causes can be cured while others can’t. If you have an underlying condition without a cure, this means that the rash may go away and then come back again in the future. A provider can help you manage the underlying condition and any symptom triggers you may have to prevent it from recurring.

When should a butterfly rash be treated by a healthcare provider?

You should call a provider any time you develop an unexplained rash. Even if you have lupus or another condition, it’s a good idea to contact your provider when a rash appears. They can provide treatment to minimize irritation, skin discoloration and inflammation.

Is it safe to cover up a butterfly rash with makeup?

Yes, it’s safe to use makeup on a butterfly rash to make it less noticeable. You should talk to your healthcare provider about what to look for when purchasing cleansers, moisturizers, cosmetics and other facial products. Hypoallergenic products are less likely to bother your skin. Make sure you remove all makeup from your skin at the end of the day or before you go to bed to prevent irritation.