From the Research
A malar rash is a distinctive butterfly-shaped red rash that appears across the cheeks and bridge of the nose, most commonly associated with systemic lupus erythematosus (SLE), and its management should prioritize sun protection and topical corticosteroids for mild cases, with oral hydroxychloroquine for more severe presentations, as supported by recent studies 1, 2. The rash affects about 50-60% of lupus patients and typically worsens with sun exposure. The rash occurs when immune system dysfunction causes inflammation in the skin cells. Key characteristics of the malar rash include:
- Butterfly-shaped appearance across the cheeks and bridge of the nose
- Reddish/salmon-coloured follicular dots surrounded by white halos ('inverse strawberry' pattern) on dermoscopy, as described in a study 3 Treatment depends on severity but often includes:
- Topical corticosteroids like hydrocortisone 1% or triamcinolone 0.1% applied twice daily for mild cases
- Oral medications such as hydroxychloroquine 200mg daily, which has been shown to have a good efficacy/toxicity balance 1 Sun protection is essential, including:
- Broad-spectrum SPF 50+ sunscreen applied every 2 hours when outdoors
- Wearing wide-brimmed hats
- Avoiding peak sun hours (10am-4pm) Patients should seek medical evaluation if they develop this rash, as it may indicate underlying autoimmune disease requiring comprehensive management. The rash itself isn't dangerous but serves as an important diagnostic clue for conditions that need proper medical attention, and recent studies have highlighted the importance of hydroxychloroquine in SLE therapy, including its ability to prevent preeclampsia in pregnant women with SLE 4, 1.