Your guide to understanding malar rash (or butterfly rash)

What is a malar rash, and what does it look like?

A malar rash is a flat or raised rash that occurs in a butterfly shape across the bridge of the nose and onto the cheeks.

It can feel bumpy or raised, or scaly, and is blotchy red or purple in color.

Causes and associated conditions

Causes of the malar rash include:

• autoimmune diseases, such as lupus
• inflammatory skin disorders, such as rosacea
• vitamin deficiencies, such as pellagra

Lupus or SLE

Lupus is a chronic autoimmune condition in which a person’s immune system mistakenly attacks healthy tissue. It is also known as systemic lupus erythematosus (SLE).

Lupus results in inflammation of joints, skin, and other organs. While there is no cure, treatment can improve some of the symptoms.

Around half of all people diagnosed with lupus will develop a malar rash as a symptom.

Rosacea

This common skin condition affects 5% of the world’s population.

• discoloration of the skin
• flushing
• hard or pus-filled pimples

Seborrheic dermatitis

Seborrheic dermatitis is a common inflammatory skin disease characterized by greasy or dry scales, typically found on the scalp, hairline, and face, although it can also affect other areas of the body.

Cellulitis

Cellulitis is a type of bacterial infection that affects the deeper skin layers, as well as the layer of fat stored directly under the skin.

Lyme disease

Lyme disease stems from tick bites, which then transmit bacteria into the body. Other symptoms may include:

• joint pain
• stiffness
• severe headaches
• dizziness

Dermatomyositis

Dermatomyositis is a condition involving inflammation of the muscles, connective tissues, and skin. Unlike SLE, the associated rash impacts the folds of skin that run from either side of the nose to the corners of the mouth.

Pellagra

When someone eats a diet that is extremely low in niacin, one of the B vitamins, it can lead to Pellagra.

This condition causes a range of symptoms that affect the skin, central nervous system, gastrointestinal system, and mucous membranes, such as the lining of the mouth. These symptoms can include pain and swelling.

Bloom syndrome

Bloom syndrome, which is also called Bloom-Torre-Machacek syndrome, is an inherited disorder that involves short stature and elevated rates of most cancers.

Among other symptoms, it causes a malar rash and skin eruptions on other areas of the body.

Homocystinuria

Homocystinuria is a genetic disorder in which the body is unable to process the amino acid methionine, resulting in elevated levels of this amino acid and its metabolite, homocysteine, in the blood and urine.

The condition can also result in vision problems, skeletal abnormalities, and intellectual disability.

Erysipelas

Erysipelas is a skin infection involving Streptococcus bacteria. It results in acute skin inflammation.

Photosensitivity

Sunburn or sensitivity to sunlight may cause a malar rash, and it may worsen if it already exists.

How is it diagnosed?

Diagnosing the condition underlying a malar rash can be challenging due to the wide range of potential causes.

A doctor will take a comprehensive and detailed medical history, investigate all other symptoms, and perform a thorough physical examination.

A healthcare professional can determine the cause through a thorough history and test findings, while a pellagra diagnosis comes through testing of niacin levels. Genetic studies can confirm genetic disorders.

If the doctor suspects SLE, they will use blood and urine tests, such as:

• SR (erythrocyte sedimentation rate) test to look for inflammation in the body
• C-reaction protein test, as high CRP levels are another sign of inflammation
• X-rays to check for organ damage
• anti-nuclear antibody test

Treatment and home remedies for malar rash

Treatment of a malar or butterfly rash depends on its cause.

Lupus

In the case of lupus, treatment involves:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Anti-inflammatory medications to reduce the inflammation and pain in muscles, joints, and other tissues.
• Anti-malarial drugs: These may help with joint and skin conditions, as well as fatigue.
• Steroids: Steroids work quickly to relieve pain, stiffness, and swelling. They have some unpleasant side effects, and the dosage is usually reduced once the disease is under control. Doctors can also prescribe steroidal creams.
• Immunosuppressive medications: These medications are also used to treat certain autoimmune diseases, such as lupus, by helping to suppress the immune system.

Rosacea

Treatment for rosacea may include topical creams or gels to help soothe and repair the skin, as well as reduce discoloration, and oral antibiotics to control inflammation.

Bacterial infection

Treatment for bacterial infection includes oral or topical antibiotics.

Home remedies for malar rash

Protecting the face from the sun helps reduce malar rash. There are several ways people can help their skin heal and prevent the rash from worsening, including:

• protecting the face from the sun
• using skin products for sensitive skin
• eating a healthful, balanced diet

Avoid foods that increase inflammation, including:

• red meat
• dairy
• fried food
• refined and processed foods
• saturated fats and hydrogenated fats
• foods high in sugar

Frequently asked questions

Summary

Malar rashes are relatively common, although they rarely pose a problem in themselves. Rashes caused by bacterial infections can be successfully treated and cured.

There is no cure for chronic diseases or genetic conditions, such as SLE and Bloom syndrome, but their rash symptoms may improve with treatment.