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The Lupus Butterfly Rash or Malar Rash: Information You Need to Know.

Posted Nov 14 2012 1:58pm


Derived from the Latin word ‘mala’ which means cheekbone, the Malar or Butterfly rash is a kind of skin condition typically characterized by the appearance of rashes across the cheekbones and over the bridge of the nose.  These rashes are usually red or purple in color in either a blotchy pattern or completely red over the affected area, and can be flat or raised in nature.  The rash can be mild or severe but is not usually painful.  It can be itchy if it is more like a rash than a blush and some patients even report a ‘hot’ feeling with more severe malar rashes. 

Lupus Butterfly RashLupus Butterfly Rash

It is called the lupus butterfly rash because of its butterfly-like shape.  Because this particular Malar rash is typical in those suffering from SLE (systemic lupus erythematosus), but even then in only around 40% of patients, it is the primary reason that most lupus organizations have the butterfly as their symbol.  Like at Molly’sFund Fighting Lupus , see our logo below!

Butterfly in the Molly' Fund Logo

  •        Systemic Lupus Erythematosus (SLE): SLE is a chronic autoimmune disease that causes an attack on the cells, tissues and organs of the body. This may actually damage the organs and/or render the organs dysfunctional.  The organs most often affected are the brain, heart, lungs, liver, kidneys, blood vessels, joints, the tissues and the skin and the overall nervous system. No one knows for sure what triggers SLE, but some suggested causes for lupus to present in the body are either genetics, or exposure to environmental pollutants. Both men and women can be affected with lupus, but it is predominately found in women between the child-bearing ages of 15-44, although children and elderly can also have lupus.  It is also more common in women or African American, Asian, and Latino decent. The lupus butterfly rash presents itself in around 40% of lupus sufferers*.
  •          Bloom Syndrome: This is a kind of syndrome that causes abnormalities in the pattern of chromosomal arrangement in a person. One of its effects in the development of rashes on the epidermis including butterfly or malar rash.
  •          Lyme disease: This disease is mostly caused by the ticks of mice which leads to the bacterial agent, named Borrelua burgdorferi affect the eyes, heart, the nervous system, the musculoskeletal system and the skin. One of the effects  on the skin can be manifested in the form of malar or butterfly rash.
  •          Erysipelas:Another bacterial agent named Streptococcal is responsible for causing acute inflammation of the skin causing red and painful lupus malar rashes.
  •          Seborrhea or Seborrheic  Dermatitis: It is a chronic skin disease that just not causes the scaling of the skin and dandruff formation in the hair but also leads to the development of rashes on the skin and scalp, including malar rashes on the face, chest and neck.
  •          Dermatomyositis:it is a connective tissue disorder that causes skin and muscular inflammation and is one of the root causes behind malar or butterfly rash.
  •          Overexposure to harmful rays of the sun also causes butterfly or malar rash, especially to those who have extreme photosensitivity.

Here is where it gets a touch confusing.  As we know, rashes, in general, can be caused by all sorts of things ranging from allergies, illnesses, body temperature shifts, to eczema, to changing your skin care products or laundry detergent.  So simply having a rash, even a butterfly rash is no reason to panic. Another factor that makes it difficult for a non-physician to determine what you may have is that Rosacea and the lupus butterfly rash can look very similar.  It is important to take into account any other unusual-to-your-body symptoms you may be experiencing; such as profound fatigue, painful swollen and/or stiff joints, fever, weight changes, and if you are presenting with *Raynaud’s Syndrome.  

         *You can read a bit more about Raynaud’s in our previous blog about lupus medications, found here: http://blog.mollysfund.org/2012/10/medications-for-lupuswhat-is-right-for.html

The American College of Rheumatology* has created a set of criteria to assist physicians in making a diagnosis of lupus. The individual must have 4 of the 11 specific criteria to be diagnosed with lupus. It is important to remember that having some of the following symptoms does not mean that lupus is the diagnosis.

The criteria include the following:
  • Malar rash - a rash shaped like a butterfly that is usually found of the bridge of the nose and the cheeks.
  •  Discoid rash - a raised rash usually found on the head, arms, chest, or back.
  • Sunlight sensitivity
  • 4 Mouth ulcers
  •  Inflammation of the joints
  •   Heart or lung involvement
  •   Kidney problems
  • Seizures or other neurological problems
  •   Positive blood tests 
  •   Changes in normal blood values

If you are having some of these symptoms, and have concerns that you may have lupus, please visit Molly's Fund Fighting Lupus-Referral Network   to find a qualified physician in your area.  (Rheumatologists are the type of doctors that typically treat lupus.)


This is not an easy distinction to make, but these following detailed descriptions may help*.  It is important that if you have any concerns about a persistent and unexplained rash, you seek medical attention immediately.
Rosacea has three stages:

1. Pre-rosacea. You flush easily, but it goes away.2. Vascular rosacea. You flush easily and it stays longer as the capillaries in your face stay dilated longer. Your skin may be more sensitive.3. Inflammatory rosacea. Skin stays red; inflammation and acne-type cysts occur. In men, the nose may become enlarged and bulbous (i.e., President Clinton had rosacea!).
As rosacea is caused by inflammation and is easily irritated, it may indeed feel hot. Never apply moisturizer to rosacea to try to calm it unless it's a dermatologist-recommended moisturizer. Rosacea can be treated with prescription topical medications that also contain moisturizer.  Rosacea rarely clears up on its own and has a tendency to worsen with time so, again, please see a medical professional for any unexplained persistent rash or irritation. 
Types of lupus rashes:
1.  The lupus butterfly rash, or acute cutaneous lupus, as mentioned and described above in the first part of this blog.

Lupus Butterfly Rash or Acute Cutaneous LupusLupus Butterfly Rash or Acute Cutaneous Lupus

2.  Subacute cutaneous lupus lesions, which can be divided into two categories.
  •  This type is highly sensitive to sun exposure and looks like red pimples as the rash begins to develop.  These pimples become larger and scales begin to appear as the rash persists.  Patients typically experience and complain of moderate to severe itching associated with this rash. Again, sun exposure usually worsens this rash, and it can appear on the face, chest, and arms, etc.
Subacute Cutaneous Lupus RashSubacute Cutaneous Lupus Rash
  •  The second type starts as flat lesions and get bigger as they expand outward.  Over time, the center of these reddened areas lightens so that eventually the rash can look like a series of circular red areas with holes in their centers.  This can appear on the face, neck, chest, arms, and back.  These rashes, too, are itchy and exacerbated by sun exposure.  These rashes usually heal without scarring, but can leave a non-depressed scar or area of depigmentation where the rash occurred.
Subacute Cutaneous Lupus RashSubacute Cutaneous Lupus Rash
         3.   Chronic cutaneous lupus lesions (otherwise known as DLE, Discoid lupus erythematosus).  These lesions are found in only about 20 percent of SLE patients. Chronic discoid lupus is also found in people who have no trace of systemic lupus.  In discoid lupus patients, the lupus is confined to the skin only.  The lesions are rarely found below the chin, occurring most often on the scalp (often causing hair loss) and outer ear, almost never on the legs. These are usually slightly elevated red or pink areas that form flakes or a crust on the surface of the skin.  The center area will become depressed and scar over time as these lesions mature.  They may be itchy and get larger, spreading outward and then leaving a central scar.  In individuals with darker complexions, the central area can become de-pigmented; in all individuals the outer red area may become hyper-pigmented.  Discoid lupus lesions can be very disfiguring and should be treated by a medical professional quickly and aggressively to stop their progression.
Chronic Cutaneous Lupus Rash ScarringSeal Has Scarring From Chronic Cutaneous Lupus
It is of crucial importance to consult a dermatologist for the treatment of malar rash or any other facial rashes since facial skin is usually very sensitive in nature. Some of the prescribed medicines and/or measures are*:
  •  Sunscreen lotions: For those whose skin is too very sensitive to the rays of the sun and are on the treatment for malar rash must apply UVA and UVB sunscreen lotions with SPF of not less than 30 in order to be protected from the harmful UV rays.
  •  Avoid sunlight as much as possible.
  •  Steroidal creams: Application of steroidal creams prescribed by the doctor helps in reducing the inflammation involved in case of malar rash and may even provide relief from itching, should that occur.  These creams may cause dilated blood vessels and should be used cautiously on the face. 
  •  Drugs: Non-steroidal drugs which are both anti-malarial and anti-inflammatory in nature are prescribed to treat lupus malar or butterfly rash. Moreover, disease modifying anti-rheumatic drugs (DMARDs) and Immunosuppressive drugs are recommended for severe malar rash. They help in treating the disease well and also prevent the recurrence of the disease.
  • Alternative home remedies for soothing skin: Besides these medications, one can also treat malar rash at home by applying vitamin E oil, olive oil, cod oil, and even a pinch of baking soda on the affected area since it reduces the irritation and pain involved. One may take a bath using oatmeal ingredients in warm water and may also apply fresh Aloe Vera gel on the affected area so to allow the fast and effective healing of the butterfly rash.
Because these rashes attack the skin, it only makes sense to protect it from direct exposure to sunlight and even florescent light exposure.  These four main rules that minimize sun exposure can help prevent and mitigate much of the discomfort that can exacerbate lupus rashes.*
Avoid Sun Exposure for Lupus Butterfly RashAvoid Sun Exposure for Lupus Butterfly Rash

·         Rule #1Stay out of the sun, especially in the middle of the day.·         Rule #2Wear good, protective sunscreen, with an SPF of 30 or higher, on all exposed areas of the skin. ·         Rule #3Wear a broad-brimmed hat when outdoors.·         Rule#4Wear long-sleeves when outdoors.

Wear Protective Clothing for Lupus RashWear Protective Clothing for Lupus Rash Prevention

We hope this blog has been helpful and informative. 
Moral of the story, if you have a persistent and unexplained rash, get it checked out by a medical professional to get proper treatment.  For those of you who have been diagnosed with lupus, are under the care of a physician already, and want to mitigate the development of rashes, stay out of the sun! 


*References taken from  HxBenefit.com, life123.com, Mayo Clinic, emedicine, American College of Rheumatology, Wikipedia, lupus.org

**Disclaimer- We, at Molly’s Fund are not physicians, we are posting this as broadly informational only, and therefore citing the references from where we find the information.  Our goal is to hopefully make topical information more clear and concise and save you some leg work!
                               
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