SLE malar rash

Image Type:   SLE malar rash  

Body Site:        Face and chest 

Description: A butterfly rash, or malar rash, appears as distinctive skin irritation resembling a butterfly across the face, extending over the cheeks and nose bridge. It is not a standalone condition but rather a symptom of underlying diseases like lupus, an autoimmune disorder that causes tissue inflammation. More prevalent in women, lupus triggers abnormal antibodies that attack the body’s own tissues, affecting multiple organs including the skin. This autoimmune response often manifests as the butterfly rash, marking the onset of lupus. Skin symptoms are common in lupus due to its systemic nature, making the butterfly rash a significant indicator for diagnosis and disease management. 

Causes: The appearance of a malar rash may indicate various underlying conditions: 

  • Systemic lupus erythematosus (SLE): An autoimmune disorder affecting individuals aged 15-50, especially women, triggers immune attacks on body tissues, including the skin, resulting in a butterfly rash. 
  • Bloom syndrome: Marked by chromosomal anomalies, it can lead to various skin rashes, including malar rash. 
  • Pellagra: Caused by vitamin B3 deficiency, may also present with a butterfly rash. 
  • Lyme disease: Transmitted by infected ticks, impacts the musculoskeletal, nervous systems, and skin, frequently exhibiting as a malar rash. 


  • Facial contact dermatitis: May result from cosmetics, chemicals, or plants, leading to a sudden onset of rash with itching, redness, blistering, and oozing. Presentation varies based on exposure. 
  • Seborrheic dermatitis: Exhibits red, sometimes yellowish, greasy plaques mainly on the face, scalp, or skin folds. 
  • Dermatomyositis: Starts with a photosensitive, reddish-purple rash, differentiating it from lupus despite some symptom overlap. 
  • Delusional beliefs: About butterfly rash may prompt medical consultation but differ from genuine medical conditions. 


  • Managing a malar or butterfly rash depends on addressing its underlying cause. 
  • For cellulitis and erysipelas: Effective management involves initiating oral or intravenous antibiotic therapy. 
  • For SLE and dermatomyositis: Treatment begins with sun protection measures such as wearing suitable clothing and using sunscreen. Further options include applying topical or intralesional corticosteroids, using antimalarial medications, and administering immunosuppressive agents. 
  • For rosacea: Therapeutic approaches may include applying gels or creams to repair the skin and reduce redness, alongside antibiotic therapy to manage inflammation. 
  • For pellagra: Typically, oral niacin or nicotinamide effectively resolves clinical symptoms associated with pellagra.