What is a Butterfly Rash?

A butterfly rash is a distinctive rash that forms across the cheeks and bridge of the nose in a shape that resembles a butterfly. Butterfly rashes are a classic sign of systemic lupus erythematosus, but they can also be associated with other conditions. People who develop a butterfly rash, and are not aware of any underlying medical condition to explain it, may want to seek an evaluation from a dermatologist. The doctor can evaluate the rash and the patient to explore possible causes and make recommendations for further testing and treatment, if necessary.
In a classic butterfly rash, the rash is reddish to purple, and it may have a scaly appearance. It does not itch and is not painful. The intensity of the rash can vary. Some people may develop a mild discoloration only, while others can develop very severe rashes that climb up around the eyes and are clearly red and scaly.
Though the rash is not painful or itchy, people may feel uncomfortable because it is highly visible. People with butterfly rashes tend to attract attention that may cause social distress or irritation, especially in the case of people who get tired of well-meaning questions about their faces. Taking anti-inflammatory drugs can sometimes reduce the intensity of the rash, and depending on the cause, there may be medications or topical creams that can be applied. Sometimes, treatment simply requires waiting the rash out until it resolves.
In addition to being associated with lupus, when it is known as a malar rash, a butterfly rash can also be caused by rosacea and many other chronic conditions. People who notice changes in their skin should take note of when the changes occur and how long they persist, in addition to listing any activities they were recently involved in, including taking medications, swimming in chlorinated water, or spending time outdoors. All of these activities can contribute to the development of a butterfly rash.
Patients with lupus may have photosensitive skin and will develop a malar rash after exposure to sunlight. The rash can also be a signal that a lupus flareup is imminent, providing warning to a patient who is familiar with the symptoms her body manifests before a flareup. Some lupus patients find it helpful to keep logs or diaries to chart their symptoms in order to familiarize themselves with warning signs and to track reactions to various activities, medications, and dietary changes.