Lupus and rosacea can both cause a butterfly-shaped rash on your face. While the two have common risk factors, they are very different conditions. To make a diagnosis, a doctor will consider the appearance of the rash and your other symptoms.

Lupus is a complex autoimmune disease that occurs when your immune system attacks your own cells and organs, including your skin.

Rosacea is a common skin condition that causes blushing or flushing and visible blood vessels on your face. The blushing might flare up for a few weeks and then disappear.

Both conditions can cause a rash on the face that appears in the shape of a butterfly across the bridge of the nose and cheeks. This is sometimes called a malar rash. Though they share this common symptom, the two conditions aren’t related.

There are subtle differences between a malar rash from rosacea and one due to lupus. If you have a malar rash, a doctor might want to conduct a few diagnostic tests to help determine the underlying cause.

A malar rash is a skin outbreak on your cheeks and the bridge of your nose. Some may call it a butterfly rash because of its shape.

Many conditions can cause a malar rash. These conditions can be systemic (affecting the whole body) or local (affecting only the skin on the face).

The exact features of a malar rash might vary depending on the underlying cause. A malar rash can have:

  • a red or purple color
  • a blotchy or solid appearance
  • flat, slightly raised, or pus-filled bumps
  • an itchy or painful sensation

Conditions that might cause a malar rash include:

Rosacea is the most common cause of a malar rash. Experts estimate at least 14 million Americans have rosacea.

A malar rash occurs in about half of people with lupus. But lupus is rare and difficult to diagnose. The Centers for Disease Control and Prevention (CDC) estimates that lupus affects about 200,000 adults in the United States.

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Both lupus and rosacea can cause a malar (butterfly) rash on your face. This rash covers your cheeks and the bridge of your nose. It does not usually affect the rest of your face. Photography courtesy of Doktorinternet/Wikimedia Doktorinternet, CC BY-SA 4.0, via Wikimedia Commons

Lupus is an autoimmune disease in which your immune system mistakenly attacks your own organs and tissues. Affected body parts include the kidneys, joints, and skin.

Lupus symptoms can be mild, like a mild rash or joint pain. They can also be more serious symptoms, like a high fever, organ damage, or severe pain.

There are a few different types of lupus. The most common type is called systemic lupus erythematosus (SLE). SLE typically affects several different organ systems of your body and can cause a range of symptoms, including skin symptoms.

A less common type of lupus called cutaneous lupus erythematosus (CLE) only affects your skin. It can cause rashes or lesions on your skin, as well as changes to your scalp that can result in hair loss. A malar rash is most often associated with CLE but can also occur in people with SLE.

Factors that impact your risk of lupus include:

  • Sex: Lupus is much more common in people assigned female at birth.
  • Age: Symptoms often start between the ages of 15 and 44.
  • Race/ethnicity: In the United States, lupus is more common in People of Color, including Black people, Hispanic people, Latino people, Asian American people, and Native American people.
  • Family history: Your risk might be higher if you have a family member with lupus.

Rosacea is an inflammatory disease that causes red bumps and flushed skin across your face. Affected areas may include your:

  • cheeks
  • chin
  • nose
  • forehead
  • eyelids

Rosacea doesn’t affect any other parts of the body.

There may be triggers that cause the flushing on your face. Common triggers include:

  • hot drinks
  • sun exposure
  • stress
  • alcohol

Factors that impact your risk of rosacea include:

  • Sex: People assigned female at birth are more likely to develop rosacea.
  • Age: People usually receive a rosacea diagnosis between the ages of 30 and 50.
  • Race/ethnicity: Rosacea is more common in white people, especially those with Celtic or Scandinavian ancestry.
  • Skin type: Rosacea more often occurs in people with light or fair skin.
  • Family history: Your risk might be higher if you have a family member with rosacea.

It can be difficult to know if a malar rash is a symptom of lupus or rosacea by just looking at the rash alone. But there might be subtle differences in the rash that could help a doctor tell the difference.

For example, unlike a rash caused by lupus, a malar rash caused by rosacea typically has pus-filled pimples and visible blood vessels under the skin. The malar rash of lupus often has a raised edge at its outside border, while rosacea lacks this.

Rosacea is limited to your face and typically doesn’t cause symptoms in other parts of your body. A doctor will likely look at more than just the malar rash to make a diagnosis.

Here’s a breakdown of some key differences between these conditions:

Symptoms• fatigue
• pain or swelling in joints
• headache
• fever
• chest pain
• sensitivity to sunlight
• hair loss
• mouth sores
• vary from person to person
• redness, flushing, or blushing on the face, often with visible blood vessels
• red or swollen eyes
Systemic or local• systemic (SLE) or localized to your skin (CLE)• localized to your face
Rash characteristics• may include disc-shaped sores or scaly lesions or small red or purple spots or bumps
• may have a raised edge at its outside border
• may be painful or itchy
• may affect the scalp and cause hair loss
• small, red, pus-filled bumps on the face that look like acne
• swollen, visible spider veins and raised patches called plaques
• redness often spreads to your forehead and chin
Duration of symptoms• some symptoms permanent
• some symptoms flare up (come and go)
• flares
Groups with higher risk• people assigned female at birth
• people ages 15–44
• People of Color
• people assigned female at birth
• people ages 30–50
• white people with fair skin

While the two conditions aren’t related, it’s possible to have both lupus and rosacea at the same time. Talk with a doctor if you think you could have both conditions.

When to contact a doctor

Most rashes aren’t serious, but they can be a symptom of an underlying condition. Consider contacting a doctor if a butterfly-shaped rash appears on your face.

A malar rash has a wide range of possible causes. Skin conditions like rosacea are usually treatable and not a cause for concern. But other conditions like lupus or Lyme disease can be more serious.

A doctor will want to evaluate all of your symptoms and conduct a thorough physical examination to help make an accurate diagnosis. Be sure to tell a doctor if you have any other symptoms, like a fever or joint pain, along with your rash.

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There’s no single test for lupus or rosacea. Lupus can be difficult to diagnose because its symptoms resemble symptoms of many other diseases.

If you have a rash on your face, a dermatologist will first examine your skin. They’ll ask you about your symptoms, including when they first started and how often they occur. The presence of visible, swollen blood vessels under your skin and pustules might help a doctor distinguish rosacea from other disorders.

Even if they think you might have rosacea, a dermatologist might want to order additional tests to help rule out other conditions like lupus.

If they suspect lupus, a rheumatologist can help make a final decision. According to the Lupus Foundation of America, it takes an average of 6 years for people to receive a lupus diagnosis from the time they first notice symptoms.

But typically, if a malar rash is present with other symptoms (such as arthritis, mouth ulcers, and Raynaud’s syndrome) and specific lab findings, a doctor can make a diagnosis.

Some tests that help identify lupus or rule out other conditions include:

These tests look for signs of anemia (low blood cell count), autoimmune antibodies, or damage to your kidney, liver, heart, or lungs.

A skin biopsy is usually not needed, but it may help confirm a CLE diagnosis. During a biopsy, a doctor removes a small sample of your skin and sends it to a laboratory for testing. This procedure can lead to scarring.

A doctor will review the results of all these tests and may consult with other specialists before making a final diagnosis.

Rosacea is localized to the skin on your face. A doctor may prescribe antibiotics or special skin creams to help repair your skin. Natural treatments and home remedies may also help with your symptoms.

Treatment for lupus depends on your symptoms. Currently, there’s no cure for lupus. If you have a rash, a doctor might prescribe steroid creams or other topical creams.

Medications are available to help you manage other lupus symptoms and prevent flares. Doctors recommend that most people with lupus take hydroxychloroquine (Plaquenil) to prevent the disease from progressing.

For severe cases, a doctor might prescribe medications that suppress the immune system, such as belimumab (Benlysta) or anifrolumab (Saphnelo).

It’s not always possible to prevent a malar rash caused by lupus or rosacea. But you might be able to prevent a flare-up by avoiding common triggers.

For example, sun exposure can trigger a malar rash in people with lupus or rosacea.

Follow these tips to help prevent a flare-up of skin symptoms:

  • Apply a broad-spectrum sunscreen of at least 30 SPF at least 20 minutes before sun exposure. Be sure to re-apply throughout the day.
  • Wear long sleeves, pants, and wide-brimmed hats when you go outside during the day. You may also consider ultraviolet (UV) protective clothing.
  • Plan outdoor activities for early in the morning or later in the evening when the sun’s rays aren’t as strong.
  • If your home gets a lot of sunlight, consider installing UV-blocking shades for your windows.

A malar or butterfly rash is a symptom of both rosacea and lupus. There are some differences in the characteristics of the rash caused by each condition. Still, it’s not always possible to diagnose them based on the appearance of the rash alone.

If you think you have a malar rash, meet with a doctor to discuss your symptoms. They’ll likely want to conduct a physical exam and other diagnostic tests before arriving at a diagnosis and treatment plan.