What Causes a Butterfly Rash and How to Treat It

If you develop redness across your nose and cheeks after being in the sun, your first thought might be a sunburn. But if the rash has a butterfly-like shape, you could have a malar rash, which is more serious.

A malar or butterfly rash is an inflammatory reaction to the sun's UV rays and a common sign of lupus. Here's how to tell what you might be dealing with and what to do to help your skin.

A malar rash is a facial rash that forms on the cheeks and the bridge of the nose and is sometimes called a butterfly rash because of its shape. It typically appears red on lighter skin tones or more violet on darker skin. It is most often a sign of the autoimmune disease lupus, but there are other causes, too.

Malar rashes are slightly bumpy with a raised border, and in some cases they can spread upward toward the forehead or down toward the chin, says Lawrence Brent, MD, associate director of the Rheumatology Fellowship Program at Temple University Hospital in Philadelphia. This kind of rash often develops after a person has spent time in the sun.

A butterfly rash is commonly caused by lupus (or systemic lupus erythematosus), an autoimmune disease where the body produces autoantibodies, or antibodies made by the immune system that are directed at the body's own proteins. These autoantibodies are deposited into the blood vessels, where a triggering event can cause an inflammatory reaction (e.g., a rash), Dr. Brent says.

The most common malar rash trigger is sun exposure. When autoantibodies in the skin react with UV light, they release inflammatory chemicals that can cause redness and bumpiness, according to the Cleveland Clinic.

About 7 in 10 people with lupus will get a butterfly rash from being in the sun, the Cleveland Clinic notes. In some cases, a red, bumpy rash will also show up on the arms, legs or other parts of the body, but they won't necessarily have a butterfly shape.

Malar rashes can be an early sign of lupus, before a person starts to notice other symptoms, Dr. Brent says.

According to the Mayo Clinic, lupus can also cause:

• Fatigue
  
• Fever
  
• Joint pain, stiffness or swelling
  
• Fingers or toes that turn white or blue when exposed to cold or when you're stressed
• Shortness of breath
  
• Chest pain
• Dry eyes
  
• Headaches
  
• Confusion or trouble remembering
  

Facial flushing across the nose and cheeks can stem from health conditions beyond lupus. Facial rashes resulting from skin conditions such as eczema, psoriasis or rosacea are sometimes mistaken for a lupus rash, according to NYU Langone Health.

Other possible causes of a butterfly rash include the following, according to the National Library of Medicine:

• ‌Cellulitis‌: A bacterial skin infection that causes redness, swelling and pain in the affected area (although this is more commonly seen on the feet and legs, per the Centers for Disease Control and Prevention)
• ‌Erysipelas:‌ Another type of skin infection that can cause redness and pain as well as fever and chills
• ‌Dermatomyositis:‌ A rare autoimmune disease that causes itchy, painful skin rashes and muscle weakness (the rash in this case is typically dark red or violet and may involve the eyelids as well as the knuckles, elbows, knees, chest and back, per the Mayo Clinic)
• ‌Pellagra:‌ A rare disease caused by vitamin B3 deficiency that's marked by inflamed skin, diarrhea, dementia and mouth sores

One condition that can look similar to a lupus rash is rosacea, a type of inflammatory skin condition that causes a red facial rash. Sunlight can trigger rosacea flares, as can heat, stress, alcohol, spicy foods and certain beauty products, per the American Academy of Dermatology.

The main difference? With rosacea, the border of the rash is flat instead of raised, Dr. Brent says. And a lupus rash tends to spare the nasolabial folds (the creases that extend between the side of your nose and corner of your mouth).

Malar rashes caused by lupus are typically treated by a dermatologist or rheumatologist. A prescription topical steroid or oral hydroxychloroquine can help reduce the redness and bumps, but it can take days or weeks for the rash to fully go away, per the Cleveland Clinic.

One plus, though: "The malar rash in lupus usually heals without scarring," Dr. Brent says.

To avoid triggering the rash in the first place, try to avoid direct exposure to the sun. Wear sun-protective clothing including a wide-brimmed hat, regularly apply sunscreen and stay in the shade during the middle of the day, when the sun's rays are strongest, recommends the National Library of Medicine.

You can also consider putting up UV-protective window coverings in your home or office and applying UV-protective window films to your car windows, per the Cleveland Clinic.

You should get a possible malar rash checked out quickly, because it can be an early sign of lupus. "Lupus can involve other organs, including the kidneys, so a prompt diagnosis is important," Dr. Brent says.

Start by seeing a dermatologist, who can examine the rash and determine whether it's caused by lupus or another condition, like rosacea.

You should also see a doctor for other unexplained rashes, ongoing fever, aches or fatigue that won't ease up, per the Mayo Clinic.

A butterfly rash can look like a bad sunburn. But it doesn't typically feel like one. Malar rashes aren't usually painful, though some people find they can be a little itchy, per the Cleveland Clinic.

No. You can't catch lupus from someone else, even if they have a rash and you touch it. Lupus is an autoimmune condition and is thought to occur due to a combination of genetics and environment. Sunlight exposure, certain infections or certain medications may trigger lupus in people who are predisposed, the Mayo Clinic notes. But the condition is not contagious.

Lupus can be challenging to diagnose. There's no single test for it, and many other conditions can cause similar symptoms. "A proper diagnosis of lupus will require a careful history, physical exam and laboratory testing," Dr. Brent says.

If your doctor suspects lupus, they will likely test your blood for ANA (anti-nuclear antibody) levels and perform a skin biopsy, which can show signs consistent with lupus or rule out other issues.