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

Lupus, an autoimmune disease that is often challenging to diagnose due to the wide array of symptoms it can cause, is estimated to affect 1.5 million Americans, according to the Lupus Foundation of America (LFA).¹ People with lupus may experience joint and muscle pain, fatigue, fever, hair loss, and anemia, to name just a handful of symptoms.

While no single symptom is enough to confirm that someone has lupus (especially considering lupus symptoms can change over time), a facial rash that blooms across the cheeks and nose, commonly referred to as a "lupus butterfly rash," occurs in 30% of patients, according to the journal Maedica.²

Also known as the malar rash, the butterfly rash is actually one of several skin concerns associated with lupus.³ Aside from its signature shape, it's usually identified by its color and texture. 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.

"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," Dr. Saxena explained, "autoimmune inflammation can occur in that area."

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

"When a butterfly rash flares up," Dr. Saxena said, "topical steroids can help decrease the inflammation, while oral steroids may provide people with 'quick relief' in particularly severe cases." However, "antimalarial and immunosuppressive medications will offer longer-term treatment," Dr. Saxena noted. 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.⁴

"It can be extremely difficult to prevent a flare-up of lupus symptoms," Dr. Saxena said. Triggers that cause a flare may include physical and emotional stress, as well as infections. But for people with lupus who experience the butterfly rash, using a broad-spectrum sunscreen, avoiding sunlight during peak hours, and covering up whenever they're outside in the sun are essential preventive measures.

Sources:

1. Lupus Foundation of America. Lupus facts and statistics: How common is Lupus and who does it affect?
2. Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD. Manifestations of systemic lupus erythematosus. Maedica (Bucur). 2011;6(4):330-336.
3. Lupus Foundation of America. Lupis and the skin.
4. Lupus Foundation of America. Medications used to treat lupus.