From the Guidelines
A malar rash, also known as a butterfly rash, is primarily caused by autoimmune conditions, most notably systemic lupus erythematosus (SLE), but can also be associated with rosacea, as evidenced by changes consistent with rosacea such as erythema and telangiectasia in malar areas 1. This distinctive rash appears as a red or purplish discoloration across the cheeks and bridge of the nose in a butterfly-like pattern.
- Other causes include:
- Dermatomyositis
- Seborrheic dermatitis
- Photosensitivity reactions to medications like tetracyclines, sulfonamides, and some NSAIDs
- Environmental triggers such as sun exposure, which can worsen the rash by triggering inflammatory responses in predisposed individuals
- Certain infections like fifth disease (parvovirus B19) that can produce a temporary malar rash The underlying mechanism involves inflammation of blood vessels in the skin, with immune complex deposition and complement activation in autoimmune cases.
- If you develop a malar rash, it is crucial to seek medical evaluation promptly as it may indicate a serious underlying condition requiring specific treatment.
- Protecting your face from sun exposure with broad-spectrum sunscreen (SPF 30+) and avoiding trigger medications can help prevent flares in susceptible individuals. Given the potential severity of underlying conditions, early diagnosis and treatment are essential to improve morbidity, mortality, and quality of life outcomes 1.
From the Research
Causes of Malar Rash
- A malar rash, also known as a butterfly rash, is a characteristic skin lesion of systemic lupus erythematosus (SLE) 2, 3, 4.
- It is a type of acute cutaneous lupus erythematosus (ACLE) that manifests as a pink-violet macule or plaque on the face, typically in a butterfly-shaped distribution across the cheeks and nose 2.
- The exact cause of malar rash is not fully understood, but it is thought to be related to the autoimmune nature of SLE, in which the immune system mistakenly attacks healthy tissues, including the skin 3, 4.
- Exposure to ultraviolet (UV) light is known to exacerbate the condition, and smoking is also a risk factor 2.
- In some cases, a malar rash can be caused by metal allergy, such as a delayed-type hypersensitivity reaction to nickel or cobalt in eyeglass frames 5.
Associated Factors
- Malar rash is often associated with systemic disease activity and can be a harbinger of SLE onset 2, 3.
- Patients with lupus-specific skin lesions, including malar rash, are more likely to have systemic involvement and disease flare 3.
- The presence of a malar rash can be an important diagnostic criterion for SLE, and its recognition is crucial for accurate diagnosis and management 4.