A malar rash, also known as a butterfly rash, may have many causes from sunburn to chronic diseases. It can often be cured.
Malar rash is a red or purplish facial rash with a “butterfly” pattern. It covers your cheeks and the bridge of your nose, but usually not the rest of the face. The rash can be flat or raised.
It may be scaly and sometimes itchy, but it doesn’t have bumps or blisters. It may also be painful.
Sunlight triggers this rash. It can appear on other parts of the body that are exposed to the sun if you’re sensitive to sunlight. The rash may come and go, and it can last for days or weeks at a time.
Many conditions may cause a malar rash:
- Rosacea, also called adult acne. Rosacea’s rash is also characterized by pimples and enlarged blood vessels.
- Lupus. A rare condition with a variety of symptoms, it can result in other types of rashes.
- Seborrheic dermatitis. With this condition, the rash could occur on your face and other areas. It also involves scaling of your skin and scalp.
- Photosensitivity. If you’re sensitive to sunlight or get too much sun, you may have a sunburn that looks like a malar rash.
- Erysipelas. Caused by Streptococcus bacteria, this infection can lead to a painful malar rash. It may also involve the ear.
- Cellulitis. This is a type of a bacterial infection affecting the deeper skin layers.
- Lyme disease. In addition to a rash, this disease, resulting from another type of bacterial infection, may also produce flu symptoms, joint pain, and many other problems.
- Bloom syndrome. This inherited chromosomal disorder has multiple additional symptoms, including skin pigmentation changes and mild intellectual disability.
- Dermatomyositis. This connective tissue disorder also causes skin inflammation.
- Homocystinuria. In addition to a malar rash, this genetic disorder may lead to vision problems and intellectual disability.
Rosacea is the most common cause of a malar rash.
It’s also very common in the population. About 16 million Americans are estimated to have rosacea.
Usually the rash is triggered by:
- spicy food
- hot drinks
With rosacea, you may have:
- redness that spreads to your forehead and chin
- visible broken spider veins on your face
- raised patches of facial skin called plaques
- thickened skin on your nose or chin
- acne breakouts
- red and irritated eyes
The cause of rosacea isn’t known. Scientists are investigating possible factors, including:
- an immune system reaction
- a gut infection
- a skin mite
- the skin protein cathelicidin
About 66 percent of people with lupus develop a skin disease. Malar rash is present in 50 to 60 percent of people with systemic lupus erythematosus, also known as acute cutaneous lupus. Lupus is a somewhat rare condition, likely underdiagnosed due to its complexity.
Other forms of lupus skin disease include:
- discoid lupus, which causes round, disk-shaped sores with raised edges, usually on the scalp and face.
- subacute cutaneous lupus, which appears as red scaly lesions with red edges, or red ring-shaped lesions
- calcinosis, which is a buildup of calcium deposits under the skin that may leak a whitish liquid
- cutaneous vasculitis lesions, which cause small reddish-purple spots or bumps on the skin
A malar rash can have many different causes, and there’s no simple way to tell if your rash is a sign of lupus. Lupus is a complex disease that affects each person differently. Symptoms may start slowly or suddenly. The symptoms also vary widely in severity.
Additional symptoms may include:
- rashes of varying types
- mouth, nose, or scalp sores
- skin sensitivity to light
- arthritis in two or more joints
- lung or heart inflammation
- kidney problems
- neurological problems
- abnormal blood tests
- immune system disorder
Having a few of these symptoms doesn’t mean that you have lupus.
Diagnosis of a malar rash can be a challenge because there are many possible causes. Your doctor will take a medical history and review all your symptoms to rule out other possibilities.
If your doctor suspects lupus or a genetic disease, they will order blood and urine tests.
Specialized tests for lupus look for:
- low white blood cell count, low platelets, or low red blood cells, which indicate anemia
- antinuclear antibodies, which are usually a probable sign of lupus
- levels of antibodies for double-stranded DNA and red blood cells
- levels of other autoimmune antibodies
- levels of proteins that have immune functions
- kidney, liver, or lung damage from inflammation
- heart damage
Treatment for malar rash depends on the severity of your rash and the suspected cause. Because sunlight is often a trigger for malar rash in general, the first line of treatment is to limit your sun exposure and use sunscreen rated at SPF 30 or more. If you have to be in the sun. wear a hat, sunglasses, and protective clothing in addition to sunscreen. Learn more about choosing a sunscreen.
Other treatments depend on the cause of the rash.
Rosacea malar rash treatment may include antibiotics, special skin creams to heal and repair your skin, and possible laser or light treatments.
If you have a bacterial infection, you’ll be prescribed a topical antibiotic. For systemic bacterial infections — that is, infections affecting the entire body — you may need oral or intravenous antibiotics.
Lupus malar rash treatment depends on the severity of your symptoms. Your doctor may prescribe:
- steroidal creams for your rash
- topical immunomodulators, such as tacrolimus ointment (Protopic)
- nonsteroidal drugs to help with inflammation
- antimalarials such as hydroxychloroquine (Plaquenil), which has been found to suppress inflammation
- immunosuppressive drugs, in more severe cases, to treat the rash and prevent its recurrence
- thalidomide (Thalomid), which has been found to improve lupus rashes that don’t respond to other treatments
You can take steps to keep your face comfortable while the rash heals.
- Wash your face with a mild, unscented soap.
- Apply small amounts of mild oils, cocoa butter, baking soda, or aloe vera gel to the rash to soothe the skin.
A malar rash may have many causes from sunburn to chronic diseases.
Rashes caused by bacterial infections can be cured. On the other hand, rosacea and lupus are both chronic diseases, for which there currently aren’t any cures. Rashes from these conditions improve with treatment, but can flare up again.
See your doctor if you have a malar rash so that they can determine the underlying cause and start you on the right treatment.