Butterfly Rash Causes and Treatment Options

If you notice 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, it could be a malar rash, which is often linked to lupus or other underlying conditions.

What Is a Butterfly Rash?

A malar rash, commonly called a butterfly rash, appears on the cheeks and bridge of the nose. It typically looks red on lighter skin tones and violet on darker skin. While lupus is the most common cause, other conditions can also trigger this type of facial rash.

According to Lawrence Brent, MD, associate director of the Rheumatology Fellowship Program at Temple University Hospital, a malar rash is slightly bumpy, has a raised border, and may spread toward the forehead or chin. The rash is often triggered by sun exposure and can indicate an underlying autoimmune condition.

Common Causes of a Butterfly Rash

1. Lupus (Systemic Lupus Erythematosus)

Lupus is an autoimmune disease where the body mistakenly attacks its own tissues, leading to inflammation. According to the Cleveland Clinic, around 70% of people with lupus develop a butterfly rash after sun exposure.

Lupus-related rashes occur when autoantibodies react with UV light, triggering an inflammatory skin response. The malar rash may be one of the earliest symptoms of lupus, appearing before joint pain, fatigue, or other signs of the disease.

2. Other Conditions That Cause Butterfly Rashes

A malar rash isn’t exclusive to lupus. Other conditions can cause similar facial redness, including:

• Rosacea – A chronic skin condition triggered by heat, stress, alcohol, or spicy foods. Unlike lupus, rosacea rashes have flat borders and often affect the nasolabial folds (the creases from the nose to the mouth).

• Cellulitis – A bacterial skin infection that causes swelling, redness, and pain.

• Erysipelas – A more severe bacterial skin infection that also leads to fever and chills.

• Dermatomyositis – A rare autoimmune disease that causes muscle weakness and red skin rashes, sometimes affecting the eyelids, knuckles, elbows, and knees.

• Pellagra – A condition caused by vitamin B3 (niacin) deficiency, leading to inflamed skin, diarrhea, and mental confusion.

Lupus Rash vs. Rosacea: Key Differences

Lupus and rosacea both cause facial redness, but they have distinct features:

How to Treat a Butterfly Rash

1. Medical Treatments

If a malar rash is linked to lupus, it’s typically managed by a dermatologist or rheumatologist. Common treatments include:

• Topical corticosteroids – Reduce redness and inflammation.

• Oral hydroxychloroquine (Plaquenil) – Used for lupus-related rashes but may take weeks to show results.

One benefit? "Lupus malar rashes usually heal without scarring," says Dr. Brent.

2. Sun Protection Strategies

Because UV light is a common trigger, preventing sun exposure is essential:

• Wear SPF 50+ sunscreen daily, even in winter.

• Use sun-protective clothing (hats, long sleeves, UV-blocking fabrics).

• Stay in the shade during peak sunlight hours.

• Apply UV-protective window films to car and home windows.

3. Lifestyle and Home Remedies

• Use gentle skincare products to avoid irritating sensitive skin.

• Keep your skin moisturized to reduce dryness and flakiness.

• Avoid known triggers (for rosacea, limit alcohol, heat, and spicy foods).

When to See a Doctor

A malar rash should be evaluated by a doctor, especially if:

• It persists for weeks or worsens.

• You have other symptoms like fatigue, joint pain, or fever.

• You experience shortness of breath or chest pain, which could indicate lupus complications.

Start with a dermatologist, who can determine if the rash is due to lupus, rosacea, or another condition. If lupus is suspected, blood tests for ANA (anti-nuclear antibodies) and skin biopsies may be needed for diagnosis.

FAQs About Butterfly Rashes

1. What Does a Butterfly Rash Feel Like?

It may look like a sunburn, but it usually isn’t painful. Some people report mild itching or tightness, according to the Cleveland Clinic.

2. Is Lupus Contagious?

No. Lupus is an autoimmune disease, not an infection, so you can’t catch it from someone else. It develops due to a combination of genetics and environmental triggers.

3. How Is Lupus Diagnosed?

Lupus diagnosis involves:

• Blood tests (checking ANA levels)

• Skin biopsies (to rule out other conditions)

• Comprehensive symptom assessment

Because lupus symptoms vary widely, a full medical evaluation is necessary.

The Bottom Line

A butterfly rash can be an early sign of lupus, but other skin conditions like rosacea, cellulitis, or dermatomyositis may cause similar symptoms. If you develop persistent facial redness, especially after sun exposure, consult a doctor for evaluation and treatment.

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