A rash across the middle section of your face in the shape of a butterfly is called a butterfly rash. Lupus is a common cause of this rash, but other conditions, like rosacea, may be the culprit.
A rash across the middle section of your face in the shape of a butterfly is called a butterfly rash. Lupus is a common cause of this rash, but other conditions, like rosacea, may be the culprit.

Skin changes can be alarming, especially when they happen on your face. Many times, a rash is the result of sun exposure or a mild allergic reaction. You can treat them using cold compresses or over-the-counter creams to bring down inflammation and stop itching.

A rash across the middle section of your face in the shape of a butterfly, though, might be a malar rash. Malar rashes are often a symptom of an underlying health condition. They won’t go away with home treatment, and you should talk to a doctor about them.

What is a malar rash?

A malar rash is sometimes called a butterfly rash because of its shape. The rash usually appears across your cheekbones and your nose. It may not spread any further than that, but in some cases, it will affect other areas of your face.

The rash is typically red, and it can be raised or flat. Some people experience dryness or scaling along with redness. You may notice that the rash is itchy or painful. It doesn’t, however, usually develop blisters or bumps.

Does lupus cause a malar rash?

This kind of rash is often associated with lupus, which is an autoimmune disorder. People with lupus have antibodies that mistakenly attack their own organs. Lupus can affect the skin, joints, kidneys, brain, and heart.

Lupus is a lifelong condition, and you will need ongoing treatment to control symptoms. You should see a rheumatologist, a doctor who specializes in joint and muscle conditions. You may need anti-malaria drugs that help reduce skin inflammation to manage the malar rash on your face.

Lupus isn’t the only syndrome that causes a malar rash, though. Your doctor will need to ask you questions and perform skin and blood tests to determine the cause of your malar rash.

What else can cause a malar rash?

Having a butterfly rash isn’t always a sign that you have lupus. There are other conditions that affect the skin and cause redness in the center of the face.

Rosacea

Rosacea is another common cause of a malar rash. Rosacea is a chronic skin condition that causes redness and irritation on the face. It usually affects adults, though children can have rosacea as well.

People with rosacea have persistent redness on their faces. It might look like flushed skin or sunburn that doesn’t go away. Rosacea can cause bumps and pimples, thickened skin, and eye irritation. Some people have visible blood vessels in their faces as well or report dry skin or skin that stings or burns.

The root cause of rosacea isn’t clear. Doctors can treat the symptoms of the condition, though, usually with prescription medication that reduce the inflammation. In some cases, laser treatments help with symptoms. Using gentle skincare products and staying out of the sun can help prevent flare-ups.

What else can cause a malar rash? (con't)

Erysipelas

Erysipelas is a type of skin infection, sometimes called cellulitis. It’s usually caused by group A streptococcal bacteria, particularly Streptococcus pyogenes. The condition happens when the bacteria get into an injury on the skin, such as a burn or scratch.

Erysipelas causes the skin around the original injury to become raised, red, and sometimes warm to the touch. You may feel pain or discomfort. Without treatment, the infection can make you feel sick. Other symptoms include fever, chills, headache, nausea, and a feeling of being run-down.

Doctors can typically diagnose erysipelas by examining the rash. They may perform a skin scraping that a lab can analyze to see which bacteria is causing the infection. They will prescribe antibiotics to clear up the infection.

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What else can cause a malar rash? (con't)

Dermatomyositis

Dermatomyositis is a rare skin and muscle disorder that can cause reddening of the skin. The exact cause of dermatomyositis isn’t clear. Experts believe that it is an autoimmune issue that causes your antibodies to attack your own cells. It may also be triggered by other health conditions such as cancer or by certain medications. There may also be a genetic cause for it.

The condition causes blood vessels in the skin to become visible and causes muscles to get inflamed and painful. The result is patches of red skin on areas such as the face and hands. This condition can also result in joint pain, muscle weakness, and difficulty moving.

Your doctor will diagnose the condition with blood tests. They will work with you to find a treatment regimen that works. You may need medicine to reduce inflammation and control pain. Physical therapy can help, though, with muscle weakness and joint problems. Some people respond well to immunoglobulin therapy or immunosuppressive drugs.

Pellagra

Pellagra is a form of malnutrition that is rare in the United States. It happens when you don’t get enough vitamin B3, also known as niacin. Certain amino acids require niacin to work properly. Amino acids form crucial proteins that fuel the body. Without them, your organ systems start to deteriorate.

The early symptoms of pellagra include a rash on the face that looks like sunburn. As the disease progresses, it can affect the digestive system, causing mouth sores, nausea, diarrhea, and vomiting. Over time, it will affect the brain and cause insomnia, hallucinations, and dementia. Untreated pellagra can lead to death in several years.

Pellagra from malnutrition is rare in the United States due to the availability of foods that contain niacin. There are other medical conditions that can lead to malnutrition and pellagra, though, including:

You will need blood tests to see if you have pellagra. You can treat the condition by taking niacin supplements. Your doctor will prescribe the appropriate dose for your condition:

If you have a rash on your face that doesn’t go away with time and home care, you should see a doctor. They will help you determine what’s causing the skin irritation. You might need blood tests or a skin biopsy to figure out the cause, but once you receive a diagnosis, your doctor can help you get the right treatment.

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Medically Reviewed on 4/11/2022
References
American Osteopathic College of Dermatology: "Pellegra."

Johns Hopkins Medicine: "Dermatomyositis."

Lupus Foundation of America: "Treating lupus: a guide."

Naji Rad S, Vashisht P, Malar Rash, StatPearls Publishing, 2022.

National Organization for Rare Diseases: "Erysipelas."

National Rosacea Society: "All About Rosacea."