The malar rash is a facial rash associated with autoimmune conditions, particularly lupus. Also known as a “butterfly rash,” it presents in a characteristic pattern across the cheeks and nose. Its appearance can be a visible indicator of underlying systemic inflammation.
What a Malar Rash Looks and Feels Like
A malar rash spreads across the bridge of the nose and extends onto both cheeks, creating a symmetrical pattern. A key diagnostic clue is that the rash spares the nasolabial folds, which are the creases running from the sides of the nose to the corners of the mouth.
The rash can appear as a flat patch of discolored skin or be slightly raised. Its color can range from red to a purplish or brown hue, depending on the person’s skin tone. While it can feel warm to the touch due to the underlying inflammation, it is not usually painful or itchy. Some individuals may experience a scaly texture to the affected skin.
The Connection to Lupus
The appearance of a malar rash is a classic sign of cutaneous, or skin, involvement in Systemic Lupus Erythematosus (SLE). It is considered one of the diagnostic criteria used by physicians when evaluating a person for lupus. The rash is a direct result of the body’s immune system mistakenly attacking healthy skin cells, causing inflammation and visible lesions on the skin’s surface.
This autoimmune response is often triggered or worsened by exposure to ultraviolet (UV) light from the sun, a condition known as photosensitivity. The malar rash is strongly linked to lupus, but not everyone with the disease will develop it; it occurs in about half of all lupus patients. For some, the rash’s appearance can signal an impending flare-up of their lupus.
Distinguishing From Other Facial Rashes
Rosacea can also cause redness across the cheeks and nose, but it often involves pimple-like bumps and visible, raised blood vessels. Unlike the malar rash, rosacea typically does not spare the nasolabial folds, with redness often extending into these creases. The skin may also feel like it is stinging or burning, sensations less common with a lupus-related rash.
Another condition, seborrheic dermatitis, is characterized by greasy, yellowish scales and can affect the face. It commonly appears in areas with more oil glands, such as the sides of the nose, between the eyebrows, and along the hairline, rather than in the butterfly pattern of a malar rash.
Simple sunburn is another source of facial redness, but it is typically painful to the touch and covers all sun-exposed skin without a specific pattern. It lacks the defined edges and nasolabial fold sparing seen with a malar rash.
Managing a Lupus Rash
The most direct way to manage the rash is through strict sun protection. Because UV light is a known trigger, consistent use of a high-SPF, broad-spectrum sunscreen is recommended, along with wearing protective clothing like wide-brimmed hats when outdoors.
A physician may prescribe topical treatments to apply directly to the rash to reduce inflammation and redness. These can include corticosteroid creams or calcineurin inhibitors, which work to calm the localized immune response in the skin. For persistent or severe rashes, managing the systemic lupus itself is necessary. This often involves oral medications prescribed by a rheumatologist to control the body’s overall autoimmune activity, which in turn helps prevent and clear up skin manifestations like the malar rash.