What Causes the Butterfly Rash in Lupus—And What To Do About It

About 50% of people with lupus experience this distinctive face rash.

The butterfly rash is one of the more iconic signs of lupus, an autoimmune disease. Lupus symptoms vary widely and are different for everyone. Some people with lupus have no visible symptoms at all. Others can experience various skin problems, like the butterfly rash.

The Lupus Foundation of America (LFA) estimates that this disease affects 1.5 million Americans. Anyone can have lupus, but according to the LFA, 90% of the people diagnosed are women.

Of the skin problem caused by lupus, the butterfly rash, according to the LFA, is rather typical. Here is what you need to know about this rash and what you can do to keep flare-ups at bay.

What Exactly Is the Butterfly Rash?

Also known as the malar rash, the lupus butterfly rash, as it is commonly called, is a facial rash that blooms across the cheeks and nose. This rash occurs in about half of all people with lupus, according to the LFA.

Aside from its signature shape, the butterfly rash is usually identified by its color and texture. It can look like a sunburn. Depending on the individual, the butterfly rash can range from a very light to a deep shade of red, and sometimes it can be raised or scaly.

The butterfly rash is actually one of several skin conditions associated with lupus, according to the LFA. Skin problems are common, occurring in about two-thirds of people with lupus, as reported by the LFA.

When lupus affects the skin, it is called cutaneous lupus. The butterfly rash falls under the type called acute cutaneous lupus. And while this rash often affects the face, it can also appear on other parts of the body, including the arms and legs.

What Causes Butterfly Rash?

"This type of lupus face rash can occur when immune-related cells in a lupus patient's skin react to damage from UV light exposure (from, for example, spending too much time in the sun) by releasing inflammatory chemicals," Amit Saxena, MD, a rheumatologist at NYU Langone's Lupus Center, told Health. "When the immune system turns on to 'clean up' damage from UV light," explained Dr. Saxena, "autoimmune inflammation can occur in that area."

"Why it often takes the shape of a butterfly remains unclear," added Dr. Saxena, suggesting, "it could be because the cheeks and nose are usually subjected to more direct sunlight exposure than the upper lip."

Sunlight is not the only source of UV light, however. Some people with lupus are also sensitive to UV rays from artificial light, like indoor lighting in offices, schools, and gyms.

How To Treat Butterfly Rash

"When a butterfly rash flares up," said Dr. Saxena, "topical steroids can help decrease the inflammation, while oral steroids may provide people with 'quick relief' in particularly severe cases." Topical steroids, like creams and gels, are applied directly to the skin, and oral steroids come in pill form and are taken by mouth.

However, "antimalarial and immunosuppressive medications will offer longer-term treatment," noted Dr. Saxena. Where the former helps protect against damage from UV light exposure, the latter reduces inflammation and the body's immune response, according to the LFA.

Treatment effectiveness can vary from person to person, depending on the type of lupus.

"It can be extremely difficult to prevent a flare-up of lupus symptoms," said Dr. Saxena. Triggers that cause a flare may include physical and emotional stress, as well as infections. For anyone managing skin conditions related to lupus, it is also good to know that these skin problems are not contagious.

For people with lupus who experience the butterfly rash, there are a few things you can try to reduce your chances of having a flare-up. The LFA offers the following tips:

  • Use a broad-spectrum sunscreen with SPF 60 or higher that blocks the two main types of ultraviolet light coming from the sun (UVA and UVB).
  • Avoid sunlight during peak hours. Try to keep outdoor activities limited to early morning or late evening. And while shade and cloud cover can help, they won't offer you full protection.
  • Cover up whenever you're outside in the sun. You can do this by wearing long sleeves, pants, and wide-brimmed hats, preferably made from fabrics that offer protection from the sun.
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