Summary about Disease
A butterfly rash, also known as a malar rash, is a distinctive facial rash characterized by redness and raised skin affecting the cheeks and bridge of the nose, resembling the shape of a butterfly's wings. It's most commonly associated with systemic lupus erythematosus (SLE), an autoimmune disease, but can also occur in other conditions like rosacea, dermatomyositis, and rarely, some infections. The rash may be accompanied by other symptoms, depending on the underlying cause.
Symptoms
The primary symptom is a reddish or purplish rash across the cheeks and bridge of the nose, often sparing the nasolabial folds (the creases between the nose and mouth). The rash can be flat or slightly raised, and may be itchy, painful, or cause a burning sensation. In lupus, the rash is often photosensitive, meaning it worsens with sun exposure. Additional symptoms depend on the underlying cause, and may include:
Joint pain and stiffness
Fatigue
Fever
Sensitivity to light
Hair loss
Mouth ulcers
Swollen lymph nodes
Causes
The most common cause is systemic lupus erythematosus (SLE), an autoimmune disease where the body's immune system attacks its own tissues and organs. Other potential causes include:
Rosacea: A chronic skin condition causing redness, visible blood vessels, and small, pus-filled bumps on the face.
Dermatomyositis: A rare inflammatory disease causing muscle weakness and skin rash.
Certain infections: Rarely, some viral or bacterial infections can trigger a butterfly rash.
Sun exposure: Can trigger or worsen the rash, especially in people with lupus.
Certain medications: Some medications can cause drug-induced lupus, which may present with a butterfly rash.
Medicine Used
Treatment depends on the underlying cause of the butterfly rash. For lupus, medications may include:
Topical Corticosteroids: Creams or ointments to reduce inflammation and itching on the skin.
Calcineurin inhibitors (e.g., tacrolimus, pimecrolimus): Topical medications to reduce inflammation.
Antimalarial drugs (e.g., hydroxychloroquine): Used to treat skin and joint symptoms and prevent lupus flares.
Corticosteroids (oral or intravenous): Powerful anti-inflammatory drugs used for more severe lupus flares.
Immunosuppressants (e.g., methotrexate, azathioprine, mycophenolate mofetil): Used to suppress the immune system and prevent organ damage in lupus.
Biologics (e.g., belimumab): Targeted therapies that block specific proteins involved in the immune response. For rosacea, treatments may include topical or oral antibiotics, retinoids, or other medications to reduce redness and inflammation. For dermatomyositis, corticosteroids and immunosuppressants are typically used.
Is Communicable
No, a butterfly rash itself is not communicable or contagious. It is a symptom of an underlying medical condition, and the underlying conditions themselves (such as lupus or rosacea) are not contagious.
Precautions
Sun Protection: Avoid prolonged sun exposure, especially during peak hours. Wear protective clothing, such as wide-brimmed hats and long sleeves. Use a broad-spectrum sunscreen with an SPF of 30 or higher daily, even on cloudy days.
Gentle Skincare: Use mild, fragrance-free cleansers and moisturizers. Avoid harsh scrubs or exfoliants.
Avoid Triggers: Identify and avoid any known triggers that worsen the rash, such as certain foods, stress, or cosmetics.
Follow Medical Advice: Adhere to your doctor's prescribed treatment plan and attend regular follow-up appointments.
Manage Stress: Practice stress-reducing techniques such as yoga, meditation, or deep breathing exercises.
Healthy Lifestyle: Maintain a healthy diet, get regular exercise, and ensure adequate sleep.
How long does an outbreak last?
The duration of a butterfly rash outbreak varies depending on the underlying cause and treatment effectiveness. In lupus, the rash may persist for weeks or months, and can recur with flares of the disease. With proper treatment and management of the underlying condition, the duration and frequency of outbreaks can be reduced.
How is it diagnosed?
Diagnosis typically involves:
Physical Examination: A doctor will examine the rash and other symptoms.
Medical History: The doctor will ask about your medical history, including any other symptoms you've experienced, medications you're taking, and family history of autoimmune diseases.
Blood Tests: Blood tests may be ordered to check for markers of inflammation, autoimmune antibodies (such as antinuclear antibodies or ANA), and organ function.
Skin Biopsy: In some cases, a skin biopsy may be performed to examine the skin cells under a microscope and help determine the cause of the rash.
Other Tests: Depending on the suspected underlying cause, other tests may be ordered, such as a complete blood count (CBC), urinalysis, or imaging studies.
Timeline of Symptoms
The timeline of symptoms can vary greatly depending on the underlying cause. In lupus, the butterfly rash may appear suddenly or gradually, and can be intermittent or persistent. Other symptoms, such as fatigue, joint pain, and fever, may precede, accompany, or follow the rash. The timeline for other conditions like rosacea is different. Usually beginning with facial redness, and progress to visible blood vessels.
Important Considerations
A butterfly rash can be a sign of a serious underlying medical condition, so it's important to see a doctor for diagnosis and treatment.
Early diagnosis and treatment of the underlying cause can help prevent complications and improve quality of life.
Sun protection is crucial for preventing and managing butterfly rashes, especially in people with lupus.
People with lupus should work closely with their healthcare team to develop a comprehensive treatment plan that addresses all of their symptoms.
It is important to be aware that the malar rash may be confused with other skin conditions, particularly rosacea. Accurate diagnosis is key for the correct treatment plan.